Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII352223 AIDS Alabama, Inc.

Covered Entity Details

Entity Name

AIDS Alabama, Inc.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII352223

Entity Address

3532 7th Court South
Birmingham, AL 35222

Grant Number

X07HA00049

Participating Start Date

1/1/2018

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

10/20/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kathie Hiers, Chief Executive Officer
(205) 324-9822

Contract Pharmacy Representative

AIDS Alabama
Kathie Hiers, Chief Executive Officer
(205) 324-9822

Signed By Date

10/11/2017

340B Drug Pricing Program Database