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MISSION WELLNESS HEALTHCARE, LLC
STD94925 The Spahr Center
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Covered Entity Details
Entity Name
The Spahr Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD94925
Entity Address
150 Nellen Avenue
100
Corte Madera, CA 94925
Grant Number
6NU62PS924557-01-02
Participating Start Date
3/15/2021
Last Recertification Date
5/10/2022
Entity Termination Date
7/1/2023
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
3/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
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
3/9/2021
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