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SHOPKO PHARMACY #2794
CH10100A MOSES LAKE COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
MOSES LAKE COMMUNITY HEALTH CENTER
Subdivision Name
QUINCY COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH10100A
Entity Address
1450 1st Ave SW
Quincy, WA 98848-1695
Grant Number
H80CS00702
Participating Start Date
7/1/2002
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2794
Pharmacy Address
814 13TH AVENUE SW
QUINCY, WA 98848
Pharmacy Comments
Contract Details
Approval Date
4/25/2014
Contract Begin Date
4/25/2014
Carve-In Effective Date
Contract Comments
4/25/2014 Immediate begin date authorized
Contract Termination Date
Termination Reason
9/30/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sheila Berschauer, CEO
(509) 765-0674 Ext: 2411
Contract Pharmacy Representative
Shopko
Tad Schilke, Director of Rx Merchandising & Marketing
(920) 429-7628
Signed By Date
4/25/2014
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