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OVERLAKE PHARMACY, LLC
CH050640 Family Health Services of Darke County
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Covered Entity Details
Entity Name
Family Health Services of Darke County
Subdivision Name
FAMILY HEALTH SERVICES OF DARKE COUNTY
Type
HRSA-Funded Health Center
340B ID
CH050640
Entity Address
5735 Meeker Rd
Greenville, OH 45331-1180
Grant Number
H80CS00419
Participating Start Date
4/1/2001
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
11/10/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jared Pollick, Executive Director
(937) 548-3806
Contract Pharmacy Representative
Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766
Signed By Date
10/14/2021
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