Contract Pharmacy Details

SHOPKO PHARMACY #2093
CH105600 Mosaic Community Health

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

SHOPKO PHARMACY #2093

Pharmacy Address

60 NE BEND RIVER MALL AVE
BEND, OR 97701

Pharmacy Comments

Contract Details

Approval Date

4/18/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/28/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Albert Noyes, Director of Retail Pharmacy
(541) 447-0707 Ext: 7060

Contract Pharmacy Representative

ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726

Signed By Date

4/18/2017

340B Drug Pricing Program Database