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MEYER
DSH380050 Sky Lakes Medical Center
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Covered Entity Details
Entity Name
Sky Lakes Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380050
Entity Address
2865 Daggett Avenue
Klamath Falls, OR 97601
Medicare Provider Number
380050
Participating Start Date
7/1/2012
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
MEYER
Pharmacy Address
2655 SHASTA WAY
KLAMATH FALLS, OR 97603
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/3/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard E. Rico, Vice President/CFO
(541) 274-6150
Contract Pharmacy Representative
Kroger health
Dana Bach, Contract Manager
(513) 562-5299
Signed By Date
10/15/2019
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