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ROCHESTER HEALTH MART PHARMACY
STD44118 Central Outreach Wellness Center
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Covered Entity Details
Entity Name
Central Outreach Wellness Center
Subdivision Name
Central Outreach Wellness Center Cleveland Heights
Type
Sexually Transmitted Diseases
340B ID
STD44118
Entity Address
2040 Lee Road
Cleveland Heights, OH 44118
Grant Number
NH25PS005134
Participating Start Date
10/1/2021
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
ROCHESTER HEALTH MART PHARMACY
Pharmacy Address
176 VIRGINIA AVE FL 3
ROCHESTER, PA 15074-1723
Pharmacy Comments
Contract Details
Approval Date
8/6/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stacy Lane, Owner
(412) 608-8313
Contract Pharmacy Representative
Northshore Pharmacy
Patrick Davis, owner
(412) 889-2311
Signed By Date
7/15/2021
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