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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH093590 UNITED COMMUNITY HEALTH CENTER-MARIA AUXILIADORA, INC.
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Covered Entity Details
Entity Name
UNITED COMMUNITY HEALTH CENTER-MARIA AUXILIADORA, INC.
Subdivision Name
CONTINENTAL FAMILY MEDICAL CTR
Type
HRSA-Funded Health Center
340B ID
CH093590
Entity Address
1260 S. CAMPBELL RD
BLDG 1
GREEN VALLEY, AZ 85614
Grant Number
H80CS00416
Participating Start Date
12/1/1992
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
7/16/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DIANNA GONZALAS, Chief Executive Officer
(520) 407-5603
Contract Pharmacy Representative
PharmBlue
Gabriel Santry, Director of National Accounts
(724) 779-4720 Ext: 017
Signed By Date
7/16/2014
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