Contract Pharmacy Details

OVERLAKE PHARMACY, LLC
CH091670 VISTA COMMUNITY CLINIC

Covered Entity Details

Entity Name

VISTA COMMUNITY CLINIC

Subdivision Name

VCC: VALE TERRACE

Type

HRSA-Funded Health Center

340B ID

CH091670

Entity Address

1000 Vale Terrace Dr.
Vista, CA 92084-5218

Grant Number

H80CS00282

Participating Start Date

4/1/1996

Last Recertification Date

2/19/2025

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

Contract Termination Date
Termination Reason

12/31/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michele Lambert, CFO
(760) 216-5803

Contract Pharmacy Representative

Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766

Signed By Date

1/15/2020

340B Drug Pricing Program Database