Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII19801 AIDS Delaware Inc

Covered Entity Details

Entity Name

AIDS Delaware Inc

Subdivision Name

Type

Ryan White Part B

340B ID

RWII19801

Entity Address

100 West 10th Street, Suite 315
Wilmington, DE 19801

Grant Number

5 X07HA00081-31-00

Participating Start Date

7/1/2013

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

6/24/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John P. Gardner, Executive Director
(302) 652-6776 Ext: 206

Contract Pharmacy Representative

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

Signed By Date

6/13/2013

340B Drug Pricing Program Database