Contract Pharmacy Details

AVITA PHARMACY 1060
CH042440 FAMILY HEALTH CARE CLINIC, INC.

Covered Entity Details

Entity Name

FAMILY HEALTH CARE CLINIC, INC.

Subdivision Name

FAMILY HEALTH CARE CLINIC, INC.--PEARL

Type

HRSA-Funded Health Center

340B ID

CH042440

Entity Address

4635 Highway 80 E
Pearl, MS 39208-4226

Grant Number

H80CS00487

Participating Start Date

7/1/2007

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

Contract Termination Date
Termination Reason

10/1/2020
Ownership change

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

340B Drug Pricing Program Database