340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII11432 AIDS Center of Queens County, Inc.
Print
Covered Entity Details
Entity Name
AIDS Center of Queens County, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII11432
Entity Address
161-21 Jamaica Avenue, 6th Floor
Jamaica, NY 11432-6113
Grant Number
X07HA00025
Participating Start Date
10/1/2013
Last Recertification Date
2/27/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
9/11/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/23/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Philip Glotzer, Executive Director
(718) 896-2500 Ext: 5729
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
9/11/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session