Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH045211A FIRST CHOICE PRIMARY CARE, INC.

Covered Entity Details

Entity Name

FIRST CHOICE PRIMARY CARE, INC.

Subdivision Name

First Choice Primary Care Warner Robins New Access Point

Type

HRSA-Funded Health Center

340B ID

CH045211A

Entity Address

207 GREEN ST
WARNER ROBINS, GA 31093-2727

Grant Number

H80CS08242

Participating Start Date

7/1/2014

Last Recertification Date

2/17/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

4/14/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/30/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Katherine McLeod, CEO
(478) 254-7204

Contract Pharmacy Representative

PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001

Signed By Date

4/14/2014

340B Drug Pricing Program Database