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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD132041 AIDS Community Resources d.b.a. ACR Health
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Covered Entity Details
Entity Name
AIDS Community Resources d.b.a. ACR Health
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD132041
Entity Address
627 W Genesee Street
Syracuse, NY 13204
Grant Number
NH25PS004347
Participating Start Date
4/1/2018
Last Recertification Date
5/27/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
2/1/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wil Murtaugh, Executive Director
(315) 475-2430 Ext: 2400
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
1/10/2018
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