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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH0318400 SAYRE HEALTH CENTER
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Covered Entity Details
Entity Name
SAYRE HEALTH CENTER
Subdivision Name
THE SAYRE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0318400
Entity Address
5800 Walnut Street Rear
Philadelphia, PA 19139
Grant Number
H80CS06645
Participating Start Date
10/1/2007
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/1/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerimiah Sabir, Executive Director/CEO
(215) 474-4444 Ext: 109
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/1/2024
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