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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD02118 Multicultural AIDS Coalition
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Covered Entity Details
Entity Name
Multicultural AIDS Coalition
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD02118
Entity Address
7 Palmer Street, 3rd Floor
Roxbury, MA 02119
Grant Number
6 NU62PS924700-01-01
Participating Start Date
4/1/2022
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
1/25/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gary K. Daffin, Executive Director
(617) 840-8604
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
1/3/2018
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