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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII36609 AIDS Alabama South, LLC
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Covered Entity Details
Entity Name
AIDS Alabama South, LLC
Subdivision Name
Type
Ryan White Part B
340B ID
RWII36609
Entity Address
4321 Downtowner Loop North
Mobile, AL 36609
Grant Number
X07HA00049
Participating Start Date
10/1/2017
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
8/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lanita Khalil, Executive Director
(251) 545-4665
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
8/7/2017
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