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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC28977-00 TRIANGLE AREA NETWORK, INC.
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Covered Entity Details
Entity Name
TRIANGLE AREA NETWORK, INC.
Subdivision Name
Triangle Area Network - Orange
Type
HRSA-Funded Health Center
340B ID
CHC28977-00
Entity Address
3727 N. 16th St.
Orange, TX 77632
Grant Number
H80CS28977
Participating Start Date
4/1/2017
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
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dena Gray Hughes, CEO
(409) 832-8338 Ext: 222
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
4/17/2017
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