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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH0452110 FIRST CHOICE PRIMARY CARE , INC
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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
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
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
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