Contract Pharmacy Details

AVITA PHARMACY 1061
CHC24162-01 OPPORTUNITIES INDUSTRIALIZATION CENTER INC

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

AVITA PHARMACY 1061

Pharmacy Address

PHARMBLUE MASSACHUSETTS LLC DBA AVITA PH
163 PLEASANT ST
ATTLEBORO, MA 02703-2457

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

340B Drug Pricing Program Database