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PROPRIUM PHARMACY
RWI00053 LGBT Life Center
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Covered Entity Details
Entity Name
LGBT Life Center
Subdivision Name
Type
Ryan White Part A
340B ID
RWI00053
Entity Address
248 W. 24th St.
Norfolk, VA 23517
Grant Number
H89HA00053
Participating Start Date
4/1/2013
Last Recertification Date
2/21/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
PROPRIUM PHARMACY
Pharmacy Address
535 INDEPENDENCE PARKWAY
SUITE 400
CHESAPEAKE, VA 23320
Pharmacy Comments
Contract Details
Approval Date
10/10/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stacie Walls-Beegle, Executive Director
(757) 640-0929 Ext: 215
Contract Pharmacy Representative
Sentara
Melissa Gallegos, Operations Manager
(757) 553-3514
Signed By Date
10/10/2017
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