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OVERLAKE PHARMACY, LLC
CH063450 PRESBYTERIAN MEDICAL SERVICES, INC.
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Covered Entity Details
Entity Name
PRESBYTERIAN MEDICAL SERVICES, INC.
Subdivision Name
PRESBYTERIAN MEDICAL SERVICES
Type
HRSA-Funded Health Center
340B ID
CH063450
Entity Address
1422 PASEO DE PERALTA
SANTA FE, NM 87501-4391
Grant Number
H80CS00205
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen M. Quesada, DIRECTOR OF PHARMACY
(505) 443-2634
Contract Pharmacy Representative
Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766
Signed By Date
7/14/2021
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