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AVITA PHARMACY 1026
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
AVITA PHARMACY 1026
Pharmacy Address
PHARMBLUE ARIZONA LLC
1260 S CAMPBELL AVE STE 1152
GREEN VALLEY, AZ 85614-0504
Pharmacy Comments
Contract Details
Approval Date
1/12/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas P. Woodworth, CFO
(520) 407-5602
Contract Pharmacy Representative
Mike Nelson, CEO
(724) 779-4720 Ext: 001
Signed By Date
1/12/2016
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