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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWI07103 North Jersey AIDS Alliance dba North Jersey Community Research Initiative (NJCRI)
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Covered Entity Details
Entity Name
North Jersey AIDS Alliance dba North Jersey Community Research Initiative (NJCRI)
Subdivision Name
Type
Ryan White Part A
340B ID
RWI07103
Entity Address
393 Central Avenue
Newark, NJ 07103
Grant Number
H89HA00003
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
7/12/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/17/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian McGovern, CEO
(973) 849-0084
Contract Pharmacy Representative
Javier Alandete, Regional Director
(724) 779-4720 Ext: 027
Signed By Date
7/12/2016
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