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MISSION WELLNESS PHARMACY
STD94114 San Francisco AIDS Foundation
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Covered Entity Details
Entity Name
San Francisco AIDS Foundation
Subdivision Name
Strut - Sexual Health Services
Type
Sexually Transmitted Diseases
340B ID
STD94114
Entity Address
470 Castro Street
San Francisco, CA 94114
Grant Number
NH25PS005141-05-08
Participating Start Date
10/1/2011
Last Recertification Date
5/22/2024
Pharmacy Details
Pharmacy Name
MISSION WELLNESS PHARMACY
Pharmacy Address
350 PARNASSUS AVE.
STE. 505
SAN FRANCISCO, CA 94117
Pharmacy Comments
Contract Details
Approval Date
7/16/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/19/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Chris Damon, Controller
(415) 487-3043
Contract Pharmacy Representative
MISSION WELLNESS HEALTHCARE, LLC
Maria Lopez, President
(415) 577-7840
Signed By Date
7/16/2019
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