Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII19904 Kent Sussex Community Services, Inc.

Covered Entity Details

Entity Name

Kent Sussex Community Services, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII19904

Entity Address

1241 College Park Drive
Dover, DE 19904

Grant Number

X07HA00081

Participating Start Date

7/1/2013

Last Recertification Date

2/5/2019

Entity Termination Date

4/1/2020

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

6/12/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

David W. Parcher, Chief Executive Officer
(302) 270-4124

Contract Pharmacy Representative

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

Signed By Date

6/10/2013

340B Drug Pricing Program Database