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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC24175-00 FAMILY AND MEDICAL COUNSELING SERVICE, INC.
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Covered Entity Details
Entity Name
FAMILY AND MEDICAL COUNSELING SERVICE, INC.
Subdivision Name
Family and Medical Counseling Service, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC24175-00
Entity Address
2041 Martin Luther King Jr Ave SE
STE 303
Washington, DC 20020-7036
Grant Number
H80CS24175
Participating Start Date
7/1/2013
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/9/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Flora Terrell Hamilton, CEO
(202) 889-7900 Ext: 217
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
4/9/2014
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