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OVERLAKE PHARMACY, LLC
CH0921760 WESTERN SIERRA MEDICAL CLINIC
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Covered Entity Details
Entity Name
WESTERN SIERRA MEDICAL CLINIC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH0921760
Entity Address
209 NEVADA STREET
DOWNIEVILLE, CA 95936
Grant Number
H80CS08234
Participating Start Date
4/1/2007
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott McFarland, Chief Executive Officer
(530) 273-4984 Ext: 115
Contract Pharmacy Representative
Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766
Signed By Date
1/15/2020
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