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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD35222 AIDS Alabama, Inc.
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Covered Entity Details
Entity Name
AIDS Alabama, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD35222
Entity Address
3529 7th Avenue South
Birmingham, AL 35222
Grant Number
5NH25PS005129-03-00
Participating Start Date
7/1/2017
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
5/5/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
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