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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC24175-01 Family and Medical Counseling Service Inc
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Covered Entity Details
Entity Name
Family and Medical Counseling Service Inc
Subdivision Name
FMCS-Seat Pleasant
Type
HRSA-Funded Health Center
340B ID
CHC24175-01
Entity Address
5936 Martin Luther King Jr Hwy
Capitol Heights, MD 20743-1757
Grant Number
H80CS24175
Participating Start Date
1/1/2023
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/16/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Flora Terrell Hamilton, CEO
(202) 889-7900 Ext: 217
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/16/2024
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