Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWI91711 Foothill AIDS Project

Covered Entity Details

Entity Name

Foothill AIDS Project

Subdivision Name

Type

Ryan White Part A

340B ID

RWI91711

Entity Address

678 S. Indian Hill Blvd. Suite 220
Claremont, CA 91711

Grant Number

H89HA00032

Participating Start Date

10/1/2012

Last Recertification Date

3/7/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

10/10/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Maritza Tona, Executive Director
(909) 482-2066 Ext: 310

Contract Pharmacy Representative

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

Signed By Date

10/10/2014

340B Drug Pricing Program Database