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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD28803 Western North Carolina AIDS Project
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Covered Entity Details
Entity Name
Western North Carolina AIDS Project
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD28803
Entity Address
554 Fairview Road
Asheville, NC 28803
Grant Number
6 NH25PS005152-05-09
Participating Start Date
1/1/2016
Last Recertification Date
5/13/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Brodderick Roary, Executive Director
(828) 252-7489
Contract Pharmacy Representative
PharmBlue
Charles Conroy, Chief Operating Officer
(724) 779-4720
Signed By Date
10/13/2017
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