Contract Pharmacy Details

ESI MAIL PHARMACY SERVICE
CAH381321-00 Grande Ronde Hospital, Inc.

Covered Entity Details

Entity Name

Grande Ronde Hospital, Inc.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH381321-00

Entity Address

900 Sunset Drive
La Grande, OR 97850

Medicare Provider Number

381321

Participating Start Date

4/1/2013

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

ESI MAIL PHARMACY SERVICE

Pharmacy Address

DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112

Pharmacy Comments

Contract Details

Approval Date

4/14/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Robert Seymour, CFO/Senior Director of Finance
(541) 963-1463

Contract Pharmacy Representative

Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500

Signed By Date

4/14/2021

340B Drug Pricing Program Database