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WAL-MART PHARMACY 10-1772
CH102910 KLAMATH HEALTH PARTNERSHIP, INC
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Covered Entity Details
Entity Name
KLAMATH HEALTH PARTNERSHIP, INC
Subdivision Name
Klamath Open Door Family Practice
Type
HRSA-Funded Health Center
340B ID
CH102910
Entity Address
2074 S 6th St
Klamath Falls, OR 97601-3372
Grant Number
H80CS00233
Participating Start Date
4/1/2001
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1772
Pharmacy Address
3600 WASHBURN WAY
KLAMATH FALLS, OR 97603
Pharmacy Comments
Contract Details
Approval Date
4/11/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Signe Porter, CFO
(541) 851-8110 Ext: 2022
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/11/2014
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