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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD48658 Central Michigan District Health Department
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Covered Entity Details
Entity Name
Central Michigan District Health Department
Subdivision Name
Standish location
Type
Sexually Transmitted Diseases
340B ID
STD48658
Entity Address
4489 W. M-61
Suite 3
Standish, MI 48658
Grant Number
NH25PS005170
Participating Start Date
1/1/2021
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jaclyn Badger, Health Promotion Director
(989) 773-5921 Ext: 1628
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
4/15/2024
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