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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC24162-01 OPPORTUNITIES INDUSTRIALIZATION CENTER INC
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Covered Entity Details
Entity Name
OPPORTUNITIES INDUSTRIALIZATION CENTER INC
Subdivision Name
OIC Family Medical Center at Happy Hill
Type
HRSA-Funded Health Center
340B ID
CHC24162-01
Entity Address
300 N GRACE ST
ROCKY MOUNT, NC 27804-5345
Grant Number
H80CS24162
Participating Start Date
7/3/2018
Last Recertification Date
2/16/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
1/13/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Bridgett Luckey, Deputy Director
(252) 210-9871
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
1/13/2016
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