Contract Pharmacy Details

AVITA PHARMACY 1060
CH0452110 FIRST CHOICE PRIMARY CARE , INC

Covered Entity Details

Entity Name

FIRST CHOICE PRIMARY CARE , INC

Subdivision Name

FIRST CHOICE PRIMARY CARE INC

Type

HRSA-Funded Health Center

340B ID

CH0452110

Entity Address

770 WALNUT STREET
MACON, GA 31201

Grant Number

H80CS08242

Participating Start Date

10/1/2007

Last Recertification Date

2/2/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1060

Pharmacy Address

RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH
40 PENNWOOD PL STE 200
WARRENDALE, PA 15086-6625

Pharmacy Comments

12/21/2012 address update (was 107 GEORGE RD EVANS CITY 16033); 2/23/11 UPDATED ZIP (WAS 16053)

Contract Details

Approval Date

10/1/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/30/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Katherine McLeod, CEO
(478) 254-7204

Contract Pharmacy Representative

PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001

Signed By Date

10/1/2013

340B Drug Pricing Program Database