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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII17701 AIDS Resource Alliance, Inc.
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Covered Entity Details
Entity Name
AIDS Resource Alliance, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII17701
Entity Address
500 W Third St
Williamsport, PA 17701
Grant Number
X07HA00021
Participating Start Date
1/1/2014
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
12/16/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/17/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kirsten Burkhart, Executive Director
(570) 322-8448 Ext: 11
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
12/9/2013
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