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YOCUMS PHARMACY INC
STD187023 Wyoming Valley AIDS Council
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Covered Entity Details
Entity Name
Wyoming Valley AIDS Council
Subdivision Name
Old River Road Clinic
Type
Sexually Transmitted Diseases
340B ID
STD187023
Entity Address
250 Old River Road
C
Wilkes Barre, PA 18702
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
8/18/2023
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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