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AVITA PHARMACY 1061
CH011580 LAMPREY HEALTH CARE
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Covered Entity Details
Entity Name
LAMPREY HEALTH CARE
Subdivision Name
LAMPREY HEALTH CARE
Type
HRSA-Funded Health Center
340B ID
CH011580
Entity Address
207 S MAIN ST.
NEWMARKET, NH 03857
Grant Number
H80CS00640
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1061
Pharmacy Address
PHARMBLUE MASSACHUSETTS LLC DBA AVITA PH
163 PLEASANT ST
ATTLEBORO, MA 02703-2457
Pharmacy Comments
Contract Details
Approval Date
4/14/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory White, CEO
(603) 659-2494 Ext: 7214
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/14/2024
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