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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD48226 Community Health Awareness Group
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Covered Entity Details
Entity Name
Community Health Awareness Group
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD48226
Entity Address
1300 W. Fort Street
Detroit, MI 48226
Grant Number
5H25PS004333
Participating Start Date
1/1/2016
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
Cindy B. Calhoun, Executive Director
(313) 963-3434 Ext: 105
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
4/15/2024
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