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AVITA PHARMACY 1060
RWII79601 Dignity Health Management Center, Inc.
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Covered Entity Details
Entity Name
Dignity Health Management Center, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII79601
Entity Address
402 Butternut St.
Abilene, TX 79602
Grant Number
X07HA00054
Participating Start Date
4/28/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1060
Pharmacy Address
RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH
40 PENNWOOD PL STE 200
WARRENDALE, PA 15086-6625
Pharmacy Comments
12/21/2012 address update (was 107 GEORGE RD EVANS CITY 16033); 2/23/11 UPDATED ZIP (WAS 16053)
Contract Details
Approval Date
7/1/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Betty Sims, Executive Director
(325) 603-0691
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
7/1/2013
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