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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC24162-04 OPPORTUNITIES INDUSTRIALIZATION CENTER, INCORPORATED
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Covered Entity Details
Entity Name
OPPORTUNITIES INDUSTRIALIZATION CENTER, INCORPORATED
Subdivision Name
OIC Family Medical Center at Community Health Plaza
Type
HRSA-Funded Health Center
340B ID
CHC24162-04
Entity Address
1041 Noell Ln, Medical Plaza B
Rocky Mount, NC 27804-2058
Grant Number
H80CS24162
Participating Start Date
4/1/2017
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
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
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
1/17/2017
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