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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD069027 Anchor Health Initiative
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Covered Entity Details
Entity Name
Anchor Health Initiative
Subdivision Name
AHI Stamford
Type
Sexually Transmitted Diseases
340B ID
STD069027
Entity Address
30 Myano Lane
Suite 16
Stamford, CT 06902
Grant Number
6NH25PS005155-05-07
Participating Start Date
7/1/2018
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/27/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia Chadwick, CEO
(203) 674-1102
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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