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PENINSULA PHARMACIES
CAH501304-00 Grays Harbor County Public Hospital District No. 1 DBA Summit Pacific Medical Center
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Covered Entity Details
Entity Name
Grays Harbor County Public Hospital District No. 1 DBA Summit Pacific Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501304-00
Entity Address
600 East Main St
Elma, WA 98541
Medicare Provider Number
501304
Participating Start Date
1/1/2015
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
PENINSULA PHARMACIES
Pharmacy Address
LONG BEACH PHARMACY
101 BOLSTAD
PO BOX 187
LONG BEACH, WA 98631
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Josh Martin, CEO
(360) 346-2244
Contract Pharmacy Representative
Medford Pharmacy Group
Ben Larsen, Pharmacy Director
(360) 562-9192
Signed By Date
1/11/2022
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