No
| Contract Detail | SHOPKO PHARMACY #2134 | SOUTH 1450 GRAND AVENUE |
| PULLMAN | WA | 99163 | 01/12/2018 | 04/01/2018 | | 11/27/2018 | 04/12/2019 |
| Contract Detail | SID'S PHARMACY | 825 SE BISHOP BLVD |
SUITE 301
| PULLMAN | WA | 99163-5512 | 10/15/2014 | 01/01/2015 | | 04/12/2023 | 04/13/2023 |
| Contract Detail | ST JOHN PHARMACY | ST JOHN PHARMACY |
10 E FRONT ST
| SAINT JOHN | WA | 99171 | 10/14/2014 | 01/01/2015 | | 04/12/2023 | 04/13/2023 |
| Contract Detail | THRIFTY PAYLESS, INC. | RITE AID #5421 |
1810 WEST PULLMAN ROAD
| MOSCOW | ID | 83843 | 07/19/2021 | 10/01/2021 | | 10/01/2023 | 05/07/2024 |
| Contract Detail | THRIFTY PAYLESS, INC. | RITE AID #5301 |
1630 SOUTH GRAND AVENUE
| PULLMAN | WA | 99163 | 07/19/2021 | 10/01/2021 | | 10/01/2023 | 05/07/2024 |
| Contract Detail | TICK KLOCK DRUG LIMITED LIABILITY COMPAN | 109 S MAIN ST |
| COLFAX | WA | 99111 | 07/06/2023 | 10/01/2023 | | | 10/01/2023 |
| Contract Detail | TICK KLOCK DRUGS | 109 S MAIN STREET |
| COLFAX | WA | 99111-1803 | 10/01/2012 | 10/01/2012 | | 10/01/2023 | 05/07/2024 |
| Contract Detail | WAL-MART CENTRAL FILL 10-2670 | 608 SPRING HILL DR # 3 SUITE 300 |
| SPRING | TX | 77386 | 10/13/2020 | 01/01/2021 | | 10/01/2023 | 05/07/2024 |
| Contract Detail | WAL-MART PHARMACY 10-1870 | 1690 SE HARVEST DR |
| PULLMAN | WA | 99163 | 10/14/2014 | 01/01/2015 | | 10/01/2023 | 05/07/2024 |
| Contract Detail | WAL-MART PHARMACY 10-5997 | 9600 PARKSOUTH CT. SUITE 100 |
| ORLANDO | FL | 32837 | 10/13/2020 | 01/01/2021 | | 10/01/2023 | 05/07/2024 |
| Contract Detail | WALMART PHARMACY 10-5169 | 2252 NORTH 8TH STREET |
SUITE A
| ROGERS | AR | 72756 | 04/13/2023 | 07/01/2023 | | 10/01/2023 | 05/07/2024 |
| CAH501327-01 | Child | CAH | Whitman Hospital and Medical Center | WHITMAN HOSPITAL AND MEDICAL CENTER - Whitman Hospital And Medical Clinics | 8 W FRONT ST | SAINT JOHN | WA | Active |
| CAH501327-02 | Child | CAH | Whitman Hospital and Medical Center | GIGS CLINIC - Gastroenterology | 1055 W FAIRVIEW ST | COLFAX | WA | Active |
| Details | Last Recertification Date | Update | Recertification | 8/24/2023 2:05:31 PM | 8/19/2024 2:03:35 PM | 8/19/2024 2:03 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2022 6:56:30 AM | 8/24/2023 2:05:31 PM | 8/24/2023 2:05 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2021 6:03:29 PM | 8/26/2022 6:56:30 AM | 8/26/2022 6:56 AM |
| Details | Last Recertification Date | Update | Recertification | 8/19/2020 12:17:02 PM | 8/26/2021 6:03:29 PM | 8/26/2021 6:03 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 102219500 (WA) | | 9/3/2020 4:06 PM |
| Medicaid Billing | NPI: Number | Delete | Change Request | 1922009448 (WA) | | 9/3/2020 4:06 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/19/2020 12:17 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 102219500 | 8/19/2020 12:17 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | WA | 8/19/2020 12:17 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1922009448 | 8/19/2020 12:17 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | WA | 8/19/2020 12:17 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1922009448 ( ) | | 8/19/2020 12:17 PM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2019 3:53:04 PM | 8/19/2020 12:17:02 PM | 8/19/2020 12:17 PM |
| Details | Last Recertification Date | Update | Recertification | 8/27/2018 12:16:27 PM | 8/21/2019 3:53:04 PM | 8/21/2019 3:53 PM |
| Contacts | Authorizing Official | Update | Change Request | Akin, Pamela
CNO
Whitman Hospital & medical Center
5092889741 | Smith, Abby
Chief Financial Officer
Whitman Hospital And Medical Center
5093973435-312 | 4/12/2019 4:19 PM |
| Details | Last Recertification Date | Update | Recertification | 11/29/2017 12:23:29 PM | 8/27/2018 12:16:27 PM | 8/27/2018 12:16 PM |
| Contacts | Primary Contact | Update | Recertification | Akin, Pamela
CNO
5092889741 | Ross, Justin
Pharmacy Manager
Whitman Hospital and Medical Center
5093973435 | 11/29/2017 12:23 PM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2016 12:00:00 AM | 11/29/2017 12:23:29 PM | 11/29/2017 12:23 PM |
| Contacts | Authorizing Official | Update | | Akin, Pamela
CNO
5092889741 | Akin, Pamela
CNO
Whitman Hospital & medical Center
5092889741 | 9/20/2017 12:40 PM |
| Addresses | Main Address | Insert | | |
1200 West Fairview
Colfax, WA 99111 | 9/7/2016 10:51 AM |
| Contacts | Signed By | Insert | | | Glass, Deborah
CEO
5093973435-365 | 9/7/2016 10:51 AM |
| Contacts | Authorizing Official | Update | | Fowler, Denise
CNO
5093975718 | Akin, Pamela
CNO
5092889741 | 9/7/2016 10:51 AM |
| Contacts | Primary Contact | Update | | Heilsberg, Jim
CFO
5093973435-312 | Akin, Pamela
CNO
5092889741 | 9/7/2016 10:51 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1922009448 | 9/7/2016 10:51 AM |
| Details | Last Recertification Date | Update | | 9/9/2015 12:00:00 AM | 9/7/2016 12:00:00 AM | 9/7/2016 10:51 AM |
| Contacts | Primary Contact | Insert | | | Heilsberg, Jim
CFO
5093973435-312 | 9/7/2016 6:39 AM |
| Contacts | Authorizing Official | Insert | | | Fowler, Denise
CNO
5093975718 | 9/9/2015 10:30 AM |
| Details | Last Recertification Date | Update | | 8/27/2014 12:00:00 AM | 9/9/2015 12:00:00 AM | 9/9/2015 10:30 AM |
| Details | Last Recertification Date | Update | | 8/23/2013 10:15:00 AM | 8/27/2014 12:00:00 AM | 8/27/2014 3:32 PM |
| Details | Last Recertification Date | Update | | | 8/23/2013 10:15:00 AM | 8/23/2013 10:15 AM |
| Details | 340B ID | Update | | IS-CA-CAH501327-00 | CAH501327-00 | 6/19/2012 1:09 PM |
| Dates | Participating Approval Date | Update | | | 6/19/2012 12:00:00 AM | 6/19/2012 1:09 PM |
| Details | State | Update | | Pending | Active | 6/19/2012 1:09 PM |
| Dates | Start Date | Update | | | 7/1/2012 12:00:00 AM | 6/19/2012 1:09 PM |
| Details | 340B ID | Update | | CA-CAH501327-00 | IS-CA-CAH501327-00 | 6/14/2012 4:52 PM |
| Details | 340B ID | Update | | CA-CA06112A | CA-CAH501327-00 | 6/12/2012 11:53 AM |
| Details | 340B ID | Update | | CA06112A | CA-CA06112A | 6/7/2012 10:40 AM |
| Details | 340B ID | Update | | ONLINE_REG | CA06112A | 6/2/2012 10:11 AM |
| Details | Last Recertification Date | Insert | | | | 6/1/2012 10:52 AM |
| Details | Grant Number | Insert | | | | 6/1/2012 10:52 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 6/1/2012 10:52 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 6/1/2012 10:52 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 6/1/2012 10:52 AM |
| Details | Medicare Provider Number | Insert | | | 501327 | 6/1/2012 10:52 AM |
| Details | Entity Name | Insert | | | Whitman Hospital and Medical Center | 6/1/2012 10:52 AM |
| Details | Program Code | Insert | | | CAH | 6/1/2012 10:52 AM |
| Details | Entity Subname | Insert | | | | 6/1/2012 10:52 AM |
| Dates | Participating Approval Date | Insert | | | | 6/1/2012 10:52 AM |
| Details | State | Insert | | | Pending | 6/1/2012 10:52 AM |
| Dates | Registration Date | Insert | | | 6/1/2012 12:00:00 AM | 6/1/2012 10:52 AM |
| Dates | Signed By Date | Insert | | | 6/1/2012 12:00:00 AM | 6/1/2012 10:52 AM |
| Dates | Start Date | Insert | | | | 6/1/2012 10:52 AM |
| Terminations | Termination Comments | Insert | | | | 6/1/2012 10:52 AM |
| Terminations | Termination Date | Insert | | | | 6/1/2012 10:52 AM |
| Terminations | Termination Effective Date | Insert | | | | 6/1/2012 10:52 AM |
| Terminations | Termination Reason | Insert | | | | 6/1/2012 10:52 AM |