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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD065193 Anchor Health Initiative
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Covered Entity Details
Entity Name
Anchor Health Initiative
Subdivision Name
AHI- New Haven
Type
Sexually Transmitted Diseases
340B ID
STD065193
Entity Address
2200 Whitney Ave
Suite 290
290
Hamden, CT 06518
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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