Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWI11217 Bridging Access to Care

Covered Entity Details

Entity Name

Bridging Access to Care

Subdivision Name

Brooklyn AIDS Task Force

Type

Ryan White Part A

340B ID

RWI11217

Entity Address

2261 Church Avenue
Brooklyn, NY 11226

Grant Number

H89HA00015

Participating Start Date

10/1/2013

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

3/25/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Glenda G. Smith, Executive Director
(347) 505-5114

Contract Pharmacy Representative

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

Signed By Date

3/25/2014

340B Drug Pricing Program Database