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PHARMBLUE LLC DBA AVITA PHARMACY 1059
Bebashi Transition to Hope
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Covered Entity Details
Entity Name
Bebashi Transition to Hope
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
Entity Address
4101 Woodland Avenue
Philadelphia, PA 19104
Grant Number
6NU62PS924728-03-04
Participating Start Date
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
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sebrina Tate, Director of Programs and Administration
(215) 769-3561 Ext: 2157693561
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
4/15/2025
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