Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC10591-00 COMMUNITY CLINIC, INC.

Covered Entity Details

Entity Name

COMMUNITY CLINIC, INC.

Subdivision Name

CCI-Takoma Park

Type

HRSA-Funded Health Center

340B ID

CHC10591-00

Entity Address

7676 NEW HAMPSHIRE AVENUE
Suite 200
TAKOMA PARK, MD 20912

Grant Number

H80CS10591

Participating Start Date

4/1/2005

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

10/7/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/1/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

MARGARET CHANG, MEDICAL DIRECTOR
(240) 499-2615

Contract Pharmacy Representative

PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001

Signed By Date

10/7/2013

340B Drug Pricing Program Database