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PEACEHEALTH RIVERBEND OUTPATIENT PHARMAC
DSH380102 SHMC-RIVERBEND
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Covered Entity Details
Entity Name
SHMC-RIVERBEND
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380102
Entity Address
3333 RIVERBEND DRIVE
SPRINGFIELD, OR 97477
Medicare Provider Number
380102
Participating Start Date
1/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
PEACEHEALTH RIVERBEND OUTPATIENT PHARMAC
Pharmacy Address
PEACEHEALTH RIVERBEND OUTPATIENT PHARMAC
3333 RIVERBEND DR
SPRINGFIELD, OR 97477
Pharmacy Comments
03/06/2014 - Pharmacy name and address correction, changed in error on 3/28/2013, see history for details.
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul J Warda, CFO
(541) 222-2034
Contract Pharmacy Representative
Peacehealth Employee Benefits Pharmacy
Vestalee Shrader, Pharmacist Manager
(541) 984-2185
Signed By Date
7/9/2020
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