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OTHELLO STATION PHARMACY
STD981181 People of Color Against AIDS Network
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Covered Entity Details
Entity Name
People of Color Against AIDS Network
Subdivision Name
MOCHA PrEP Clinic
Type
Sexually Transmitted Diseases
340B ID
STD981181
Entity Address
4437 Rainier Ave South
Seattle, WA 98118
Grant Number
NU62PS924528
Participating Start Date
5/11/2022
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
OTHELLO STATION PHARMACY
Pharmacy Address
SALAAM HEALTH PLLC
4219 S OTHELLO ST # 105F
SEATTLE, WA 98118-3892
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Sawyer, Director
(206) 322-7061 Ext: 24
Contract Pharmacy Representative
AVENTI HEALTH
ERIC FROMHART, ATTORNEY
(971) 322-4935
Signed By Date
10/16/2023
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