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OVERLAKE PHARMACY, LLC
CH101340 YAKIMA NEIGHBORHOOD HEALTH SERVICES
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Covered Entity Details
Entity Name
YAKIMA NEIGHBORHOOD HEALTH SERVICES
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH101340
Entity Address
12 SOUTH 8TH STREET
YAKIMA, WA 98901
Grant Number
H80CS06078
Participating Start Date
4/1/1999
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
10/7/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rhonda Hauff, CEO
(509) 574-5552
Contract Pharmacy Representative
Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766
Signed By Date
10/7/2021
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