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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD199581 Beebe Healthcare
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Covered Entity Details
Entity Name
Beebe Healthcare
Subdivision Name
Population Health Mobile Unit
Type
Sexually Transmitted Diseases
340B ID
STD199581
Entity Address
34382 Carpenters Way
# 7&8
Lewes, DE 19958
Grant Number
NH25PS0051560100
Participating Start Date
10/1/2023
Last Recertification Date
5/27/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/10/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Blanch, Director Population Health & Community Outreach
(302) 645-3100 Ext: 5056
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/10/2024
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