340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD187023 Wyoming Valley AIDS Council
Print
Covered Entity Details
Entity Name
Wyoming Valley AIDS Council
Subdivision Name
Old River Road Clinic
Type
Sexually Transmitted Diseases
340B ID
STD187023
Entity Address
250 Old River Road
C
Wilkes Barre, PA 18702
Grant Number
NH25PS005144-05-06
Participating Start Date
10/1/2023
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
10/1/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KEN J ZULA, EXECUTIVE DIRECTOR
(570) 823-5808 Ext: 302
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/1/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session