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CUSTOM PRESCRIPTION SHOPPE
CH100570 COLUMBIA VALLEY COMMUNITY HEALTH
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Covered Entity Details
Entity Name
COLUMBIA VALLEY COMMUNITY HEALTH
Subdivision Name
CVCH Wenatchee Clinic
Type
HRSA-Funded Health Center
340B ID
CH100570
Entity Address
600 Orondo Ave STE 1
Wenatchee, WA 98801
Grant Number
H80CS00574
Participating Start Date
12/1/1992
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
CUSTOM PRESCRIPTION SHOPPE
Pharmacy Address
5917 PORTAL WAY
FERNDALE, WA 98248
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/2/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Russell Olson, CEO
(509) 662-6000
Contract Pharmacy Representative
Western Pharmacy Group LLC
KEVIN FARIS, CEO
(360) 685-4263
Signed By Date
10/8/2018
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