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MISSION WELLNESS PHARMACY
STD941031 San Francisco AIDS Foundation
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Covered Entity Details
Entity Name
San Francisco AIDS Foundation
Subdivision Name
1035 Satellite Clinic
Type
Sexually Transmitted Diseases
340B ID
STD941031
Entity Address
1035 Market Street, Suite 400
San Francisco, CA 94103
Grant Number
6NH25PS005141
Participating Start Date
4/1/2015
Last Recertification Date
5/10/2023
Entity Termination Date
4/1/2024
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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