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OVERLAKE PHARMACY, LLC
CH04102D GREENE COUNTY HEALTH CARE, INCORPORATED
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Covered Entity Details
Entity Name
GREENE COUNTY HEALTH CARE, INCORPORATED
Subdivision Name
WALSTONBURG HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH04102D
Entity Address
204 S Main St
Walstonburg, NC 27888
Grant Number
H80CS00088
Participating Start Date
4/1/2007
Last Recertification Date
2/16/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
7/19/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul Daniel Perritt, Consulting Chief Financial Officer
(252) 747-8162 Ext: 2001
Contract Pharmacy Representative
Overlake Pharmacy LLC
Thao Phan, Pharmacist in Charge
(425) 968-8766
Signed By Date
7/19/2022
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