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YOCUMS PHARMACY INC
STD18202 Wyoming Valley AIDS Council
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Covered Entity Details
Entity Name
Wyoming Valley AIDS Council
Subdivision Name
Hazleton Clinic
Type
Sexually Transmitted Diseases
340B ID
STD18202
Entity Address
426 Airport Beltway
130
Hazleton, PA 18202
Grant Number
NH25PS005144-05-06
Participating Start Date
10/1/2023
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
YOCUMS PHARMACY INC
Pharmacy Address
1749 E BROAD ST
HAZLETON, PA 18201
Pharmacy Comments
Contract Details
Approval Date
9/4/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KEN J ZULA, EXECUTIVE DIRECTOR
(570) 823-5808 Ext: 302
Contract Pharmacy Representative
Yocums Pharmacy
Hirshil Patel, Member
(484) 725-0081
Signed By Date
7/5/2023
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