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OVERLAKE PHARMACY, LLC
STD331381 Community Rightful Center, Inc.
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Covered Entity Details
Entity Name
Community Rightful Center, Inc.
Subdivision Name
Prevention, Education, Testing, Treatment and Case Management
Type
Sexually Transmitted Diseases
340B ID
STD331381
Entity Address
9526 NE 2 Ave #202D
Suite 202D
Miami Shores, FL 33138
Grant Number
NU62PS924532
Participating Start Date
11/26/2019
Last Recertification Date
5/30/2025
Pharmacy Details
Pharmacy Name
OVERLAKE PHARMACY, LLC
Pharmacy Address
4124 148TH AVE NE STE JA
REDMOND, WA 98052
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roseline Lous XVI, CEO/ director
(305) 754-5701
Contract Pharmacy Representative
Independent Medical Group
Sam Possert, Account Executive
(813) 502-7089
Signed By Date
10/14/2022
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