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CVS CAREMARK
CAH501317-00 Grant County Public Hospital District #3, dba Columbia Basin Hospital
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Covered Entity Details
Entity Name
Grant County Public Hospital District #3, dba Columbia Basin Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501317-00
Entity Address
200 Nat Washington Way
Ephrata, WA 98823-1982
Medicare Provider Number
501317
Participating Start Date
7/1/2013
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CVS CAREMARK
Pharmacy Address
DBA CVS/CAREMARK OR CF# 11506
1 GREAT VALLEY BOULEVARD
WILKES BARRE, PA 18706
Pharmacy Comments
Contract Details
Approval Date
10/3/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anthonie Zimmermann, CFO
(732) 552-5812
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/3/2024
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