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NPS PHARMACY AT ETSU
RWI23669B LGBT Life Center
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Covered Entity Details
Entity Name
LGBT Life Center
Subdivision Name
Type
Ryan White Part A
340B ID
RWI23669B
Entity Address
5360 Robin Hood Road
202
Norfolk, VA 23513
Grant Number
H89HA00053
Participating Start Date
2/1/2023
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
NPS PHARMACY AT ETSU
Pharmacy Address
615 N STATE OF FRANKLIN RD
JOHNSON CITY, TN 37604-8209
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stacie Walls-Beegle, CEO
(757) 640-0929 Ext: 215
Contract Pharmacy Representative
NPS
John Winnett, Chief Strategy Officer
(615) 831-2291 Ext: 301
Signed By Date
4/10/2023
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