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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH04244J 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., Flowood
Type
HRSA-Funded Health Center
340B ID
CH04244J
Entity Address
1307 Airport Road, Bldg. 2
Flowood, MS 39232
Grant Number
H80CS00487
Participating Start Date
7/1/2007
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
10/13/2017
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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