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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWI19107E ActionAIDS dba Action Wellness
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Covered Entity Details
Entity Name
ActionAIDS dba Action Wellness
Subdivision Name
Casa Nueva Vida
Type
Ryan White Part A
340B ID
RWI19107E
Entity Address
2641 N. 6th Street
Philadelphia, PA 19133
Grant Number
H89HA00013
Participating Start Date
4/1/2018
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/2/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin J. Burns, Executive Director
(215) 981-3338
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
4/2/2018
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