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OVERLAKE PHARMACY, LLC
CH090780 Community Medical Centers, Inc.
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Covered Entity Details
Entity Name
Community Medical Centers, Inc.
Subdivision Name
Community Medical Centers, Channel
Type
HRSA-Funded Health Center
340B ID
CH090780
Entity Address
701 E Channel St.
Stockton, CA 95202-2628
Grant Number
H80CS00138
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
5/11/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christine Noguera, CEO
(209) 373-2826
Contract Pharmacy Representative
Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766
Signed By Date
4/15/2020
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