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DEBLAQUIERE ENT. INC.
CAH501310-01 Pend Oreille County Public Hospital District #1 DBA Newport Community Hospital
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Covered Entity Details
Entity Name
Pend Oreille County Public Hospital District #1 DBA Newport Community Hospital
Subdivision Name
Newport Health Center
Type
Critical Access Hospital
340B ID
CAH501310-01
Entity Address
714 W. Pine Street
Newport, WA 99156
Medicare Provider Number
501310
Outpatient Facility Provider Number
508500
Participating Start Date
10/1/2012
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
DEBLAQUIERE ENT. INC.
Pharmacy Address
DBA WHITE CROSS PHARMACY - OLDTOWN
86 TANK RD
OLDTOWN, ID 83822
Pharmacy Comments
Contract Details
Approval Date
1/8/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Manus, CFO
(509) 447-2441 Ext: 4226
Contract Pharmacy Representative
Deblaquiere ENT. INC.
Richard De Blaquiere, OWNER/PHARMACIST
(208) 448-1633
Signed By Date
1/8/2021
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