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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWI92345 Foothill AIDS Project
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Covered Entity Details
Entity Name
Foothill AIDS Project
Subdivision Name
Hesperia
Type
Ryan White Part A
340B ID
RWI92345
Entity Address
16501 Walnut Street Unit 8
Hesperia, CA 92345
Grant Number
H89HA00032
Participating Start Date
7/1/2013
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
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