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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH060060 Lee County Cooperative Clinic dba Olly Neal Community Health Center
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Covered Entity Details
Entity Name
Lee County Cooperative Clinic dba Olly Neal Community Health Center
Subdivision Name
Lee County Cooperative Clinic dba Olly Neal Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH060060
Entity Address
558 Atkins Blvd
Marianna, AR 72360-2113
Grant Number
H80CS00122
Participating Start Date
12/1/1992
Last Recertification Date
3/10/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
11/1/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CLIFTON COLLIER, CEO
(870) 295-5225 Ext: 103
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
11/1/2016
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