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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD199662 YMS Mental Health Services LLC
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Covered Entity Details
Entity Name
YMS Mental Health Services LLC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD199662
Entity Address
230 Mitchell Street
Millsboro, DE 19966
Grant Number
NH25PS005156
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
9/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jenna Blackwell, Owner/Nurse Practitioner
(302) 591-9179
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
7/4/2024
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