Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC26572-02 MyCare Heatlh Center

Covered Entity Details

Entity Name

MyCare Heatlh Center

Subdivision Name

Clinton Township

Type

HRSA-Funded Health Center

340B ID

CHC26572-02

Entity Address

42627 Garfield Rd STE 213
Clinton Township, MI 48038-5032

Grant Number

H80CS26572

Participating Start Date

7/1/2014

Last Recertification Date

2/17/2017

Entity Termination Date

4/1/2017

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

7/18/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2017

Contacts

Covered Entity Signing Official

Darlene Vasi, CEO
(248) 689-1340

Contract Pharmacy Representative

PharmBlue
Gabriel Santry, Director of National Accounts
(724) 779-4720 Ext: 017

Signed By Date

7/18/2014

340B Drug Pricing Program Database