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PROPRIUM PHARMACY
RWI23669A LGBT Life Center
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Covered Entity Details
Entity Name
LGBT Life Center
Subdivision Name
Type
Ryan White Part A
340B ID
RWI23669A
Entity Address
20 Settlers Landing Road
Hampton, VA 23669
Grant Number
H89HA00053
Participating Start Date
1/1/2024
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
PROPRIUM PHARMACY
Pharmacy Address
535 INDEPENDENCE PARKWAY
SUITE 400
CHESAPEAKE, VA 23320
Pharmacy Comments
Contract Details
Approval Date
8/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stacie Walls-Beegle, CEO
(757) 640-0929 Ext: 215
Contract Pharmacy Representative
Sentara Enterprises
Jim R Schwamburger, Director
(757) 553-3211
Signed By Date
7/12/2018
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