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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD105321 Hudson Valley Community Services
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Covered Entity Details
Entity Name
Hudson Valley Community Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD105321
Entity Address
40 Saw Mill River Road
Hawthorne, NY 10532
Grant Number
H25PS004347
Participating Start Date
10/1/2017
Last Recertification Date
5/6/2020
Entity Termination Date
7/1/2021
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
7/28/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
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