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AVITA PHARMACY 1060
CH04244K FAMILY HEALTH CARE CLINIC, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CARE CLINIC, INC.
Subdivision Name
Family Health Care Clinic, Inc., Decatur
Type
HRSA-Funded Health Center
340B ID
CH04244K
Entity Address
1304 13th Ave SE STE A
Decatur, AL 35601-4316
Grant Number
H80CS00487
Participating Start Date
4/1/2010
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1060
Pharmacy Address
RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH
40 PENNWOOD PL STE 200
WARRENDALE, PA 15086-6625
Pharmacy Comments
12/21/2012 address update (was 107 GEORGE RD EVANS CITY 16033); 2/23/11 UPDATED ZIP (WAS 16053)
Contract Details
Approval Date
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARGARET A. GRAY, PRESIDENT & CEO
(601) 825-7280 Ext: 5005
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
10/13/2017
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