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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC24149-00 MERCY HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
MERCY HEALTH SERVICES, INC.
Subdivision Name
Mercy Health Services
Type
HRSA-Funded Health Center
340B ID
CHC24149-00
Entity Address
143 SE Parkway Ct
Franklin, TN 37064
Grant Number
H80CS24149
Participating Start Date
1/1/2013
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David Winningham, CEO
(615) 790-0567 Ext: 232
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
10/15/2015
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