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WASHINGTON CVS PHARMACY, L.L.C.
DSH500150 LEGACY SALMON CREEK HOSPITAL
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Covered Entity Details
Entity Name
LEGACY SALMON CREEK HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500150
Entity Address
2211 NE 139TH ST
VANCOUVER, WA 98686
Medicare Provider Number
500150
Participating Start Date
7/1/2007
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
WASHINGTON CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16168
205 THREE RIVERS DR
KELSO, WA 98626
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anna Loomis, SVP Chief Financial Officer
(503) 415-5730
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2020
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