Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWI37211 Women On Maintaining Education and Nutrition

Covered Entity Details

Entity Name

Women On Maintaining Education and Nutrition

Subdivision Name

Type

Ryan White Part A

340B ID

RWI37211

Entity Address

417 Welshwood Drive
Nashville, TN 37211

Grant Number

H89HA11433

Participating Start Date

7/1/2015

Last Recertification Date

2/23/2017

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

4/22/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/30/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Catherine Wyatt-Morley, CEO
(615) 256-3882

Contract Pharmacy Representative

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

Signed By Date

4/22/2015

340B Drug Pricing Program Database