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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWI06511 APNH: A Place to Nourish Your Health, Inc.
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Covered Entity Details
Entity Name
APNH: A Place to Nourish Your Health, Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI06511
Entity Address
1302 Chapel Street
New Haven, CT 06511
Grant Number
H89HA00029
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
3/18/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Allen Cole, Executive Director
(475) 441-7017
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
3/13/2014
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