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PENINSULA PHARMACIES INC
CAH381320-00 Columbia Lutheran Charities DBA Columbia Memorial Hospital
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Covered Entity Details
Entity Name
Columbia Lutheran Charities DBA Columbia Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381320-00
Entity Address
2111 Exchange Street
Astoria, OR 97103-3329
Medicare Provider Number
381320
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
PENINSULA PHARMACIES INC
Pharmacy Address
ILWACO DRUG CO
101 1ST AVE S
PO BOX B
ILWACO, WA 98624
Pharmacy Comments
Contract Details
Approval Date
7/7/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Zachary Schmitt, Chief Financial Officer
(503) 338-7505
Contract Pharmacy Representative
Peninsula Pharmacies Inc.
JEFF HARRELL, PRESIDENT
(360) 642-3200
Signed By Date
7/7/2020
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