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ROCHESTER HEALTH MART PHARMACY
STD42304 Central Outreach Wellness Center
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Covered Entity Details
Entity Name
Central Outreach Wellness Center
Subdivision Name
Central Outreach Wellness Center Columbus
Type
Sexually Transmitted Diseases
340B ID
STD42304
Entity Address
2680 W Broad Street
Columbus, OH 43204
Grant Number
NH25PS005134
Participating Start Date
7/1/2022
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
5/9/2022
Contract Begin Date
7/1/2022
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
4/15/2022
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