Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII18603 Caring Communities For AIDS, Inc.

Covered Entity Details

Entity Name

Caring Communities For AIDS, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII18603

Entity Address

60 Public Square
FL 7
Wilkes-Barre, PA 18701

Grant Number

X07HA00021

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

12/11/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/11/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Christopher Kupchik, Executive Director
(570) 829-2700 Ext: 202

Contract Pharmacy Representative

PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033

Signed By Date

12/10/2013

340B Drug Pricing Program Database