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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII97403 HIV Alliance
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Covered Entity Details
Entity Name
HIV Alliance
Subdivision Name
Type
Ryan White Part B
340B ID
RWII97403
Entity Address
1195 A City View Street
Eugene, OR 97402
Grant Number
X07HA00007
Participating Start Date
10/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
9/10/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Renee Yandel, Executive Director
(541) 342-5088 Ext: 118
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
9/10/2015
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