340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PHARMBLUE LLC DBA AVITA PHARMACY 1059
HV00816E Robeson Health Care Corporation
Print
Covered Entity Details
Entity Name
Robeson Health Care Corporation
Subdivision Name
Montgomery Health Center
Type
Ryan White Part C
340B ID
HV00816E
Entity Address
103 Cotton Creek Road
Star, NC 27356-7343
Grant Number
H76HA00816
Participating Start Date
4/1/2013
Last Recertification Date
2/9/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/22/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Thomas E. Manynor II, Deputy President and CEO
(910) 521-2900 Ext: 104
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
10/22/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session