Contract Pharmacy Details

MISSION WELLNESS HEALTHCARE, LLC
RWI94925 The Spahr Center

Covered Entity Details

Entity Name

The Spahr Center

Subdivision Name

Type

Ryan White Part A

340B ID

RWI94925

Entity Address

1575 Francisco Blvd E
Corte Madera, CA 94901

Grant Number

H89HA00006

Participating Start Date

1/1/2024

Last Recertification Date

1/29/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

MISSION WELLNESS HEALTHCARE, LLC

Pharmacy Address

DBA MISSION WELLNESS PHARMACY
2424 MISSION ST
SAN FRANCISCO, CA 94110-2415

Pharmacy Comments

Contract Details

Approval Date

8/25/2020

Contract Begin Date

8/25/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Dana Van Gorder, Executive Director
(415) 886-8551

Contract Pharmacy Representative

MISSION WELLNESS HEALTHCARE, LLC
Maria Lopez, President
(415) 577-7840

Signed By Date

8/25/2020

340B Drug Pricing Program Database