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LAKETOWN PHARMACY PLLC
SCH500033-00 SAMARITAN HEALTHCARE
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Covered Entity Details
Entity Name
SAMARITAN HEALTHCARE
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH500033-00
Entity Address
801 EAST WHEELER ROAD
MOSES LAKE, WA 98837
Medicare Provider Number
500033
Participating Start Date
7/1/2020
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
LAKETOWN PHARMACY PLLC
Pharmacy Address
LAKETOWN PHARMACY
1550 S PIONEER WAY STE 105
MOSES LAKE, WA 98837
Pharmacy Comments
Contract Details
Approval Date
6/3/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alexander Town, Chief Financial Officer
(509) 793-9710
Contract Pharmacy Representative
Laketown Pharmacy
John Rackham, Owner
(509) 765-8891
Signed By Date
6/3/2020
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