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OVERLAKE PHARMACY, LLC
CH021270 COMMUNITY HEALTH CARE, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CARE, INC.
Subdivision Name
CompleteCare Adult & Specialty Medical Professionals
Type
HRSA-Funded Health Center
340B ID
CH021270
Entity Address
30 N Pearl St
BRIDGETON, NJ 08302
Grant Number
H80CS00164
Participating Start Date
1/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
10/19/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James C. Edwards, CEO
(856) 451-4700 Ext: 2070
Contract Pharmacy Representative
Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766
Signed By Date
10/19/2021
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