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IC PHARMACY LLC
CH092420 OLE HEALTH
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Covered Entity Details
Entity Name
OLE HEALTH
Subdivision Name
OLE Health - North Napa Campus
Type
HRSA-Funded Health Center
340B ID
CH092420
Entity Address
1141 PEAR TREE LANE
Suite 100
NAPA, CA 94558-6485
Grant Number
H80CS04219
Participating Start Date
10/1/2004
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
IC PHARMACY LLC
Pharmacy Address
AMAZON PHARMACY #004
34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYN, NY 11232
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin E. Moses, Legal Officer
(707) 254-1774 Ext: 8222
Contract Pharmacy Representative
PillPack by Amazon Pharmacy
John Lavin, Vice President
(714) 380-0579
Signed By Date
10/15/2024
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