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WAL-MART PHARMACY 10-2492
CAH381325-00 GOOD SHEPHERD MEDICAL CENTER
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Covered Entity Details
Entity Name
GOOD SHEPHERD MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381325-00
Entity Address
610 N.W. 11TH STREET
HERMISTON, OR 97838
Medicare Provider Number
381325
Participating Start Date
9/29/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2492
Pharmacy Address
2203 SW COURT PLACE
PENDLETON, OR 97801
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
7/24/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/2/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DENNIS BURKE, PRESIDENT/CEO
(541) 667-3409
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/9/2020
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