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BLW INC
CH105600 Mosaic Community Health
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Covered Entity Details
Entity Name
Mosaic Community Health
Subdivision Name
Madras Health Center
Type
HRSA-Funded Health Center
340B ID
CH105600
Entity Address
500 NE A St Ste 100
Madras, OR 97741
Grant Number
H80CS00270
Participating Start Date
10/1/2003
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
BLW INC
Pharmacy Address
HOMETOWN DRUGS
65 NE OAK ST STE 100
MADRAS, OR 97741-1814
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Albert Noyes, Director of Retail Pharmacy
(541) 447-0707 Ext: 7060
Contract Pharmacy Representative
BLW INC
Amanda Gaddy, Pharmacy Representative
(404) 313-5500
Signed By Date
1/15/2020
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