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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII13204 AIDS Community Resources, Inc.
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Covered Entity Details
Entity Name
AIDS Community Resources, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII13204
Entity Address
627 West Genesee Street
Syracuse, NY 13204
Grant Number
X07HA00025-34-01
Participating Start Date
1/1/2014
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
12/6/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Crinnin, Executive Director
(315) 475-2430
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
11/15/2013
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