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OVERLAKE PHARMACY, LLC
CH093210 Camarena Health
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Covered Entity Details
Entity Name
Camarena Health
Subdivision Name
DMC WOMEN'S CARE HEALTH CTR
Type
HRSA-Funded Health Center
340B ID
CH093210
Entity Address
201 S B St
Madera, CA 93638-3719
Grant Number
H80CS00143
Participating Start Date
4/1/2001
Last Recertification Date
1/31/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paulo A. Soares, CEO
(559) 664-4089
Contract Pharmacy Representative
Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766
Signed By Date
1/14/2020
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