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ADVANCECARE SAN FRANCISCO INC
RWI89106 COMMUNITY OUTREACH MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY OUTREACH MEDICAL CENTER
Subdivision Name
Type
Ryan White Part A
340B ID
RWI89106
Entity Address
2080 E. Flamingo Rd
Suite 302
Las Vegas, NV 89119
Grant Number
H89HA06900
Participating Start Date
4/1/2006
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
ADVANCECARE SAN FRANCISCO INC
Pharmacy Address
MISTR SF
2301 MARKET ST
SAN FRANCISCO, CA 94114
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
kema ogden, Executive Director
(702) 604-6052
Contract Pharmacy Representative
AdvanceCare Pharmacy
Kyle Bernier, Director of Operations
(508) 971-8380
Signed By Date
10/7/2024
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