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870 SOUTHERN DRUG CORP
RWI11217 Bridging Access to Care
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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
870 SOUTHERN DRUG CORP
Pharmacy Address
D/B/A AVITA PHARMACY 1064
924 MYRTLE AVE
BROOKLYN, NY 11206
Pharmacy Comments
Contract Details
Approval Date
7/12/2017
Contract Begin Date
10/1/2017
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
7/12/2017
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