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OTHELLO STATION PHARMACY
RWI98118 People of Color Against AIDS Network
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Covered Entity Details
Entity Name
People of Color Against AIDS Network
Subdivision Name
POCAAN
Type
Ryan White Part A
340B ID
RWI98118
Entity Address
4437 Rainier Ave South
Seattle, WA 98118
Grant Number
H89HA00022
Participating Start Date
4/20/2022
Last Recertification Date
2/10/2025
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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