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NORTH SHORE HEALTH MART PHARMACY
STD15301 Central Outreach Wellness Center, LLC
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Covered Entity Details
Entity Name
Central Outreach Wellness Center, LLC
Subdivision Name
Central Outreach Wellness Center, LLC South Office
Type
Sexually Transmitted Diseases
340B ID
STD15301
Entity Address
817 Jefferson Avenue
Washington, PA 15301
Grant Number
NH25PS005144
Participating Start Date
4/1/2018
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
NORTH SHORE HEALTH MART PHARMACY
Pharmacy Address
MEMAW, INC D/B/A:
127 ANDERSON ST STE 101
PITTSBURGH, PA 15212-5803
Pharmacy Comments
Contract Details
Approval Date
7/1/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stacy Lane, Owner
(412) 608-8313
Contract Pharmacy Representative
Northshore Pharmacy
Patrick Davis, owner
(412) 889-2311
Signed By Date
7/1/2019
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