340B Drug Pricing Program Database

Pharmacy Name

SAMARITAN ALBANY GENERAL HOSPITAL

Pharmacy Address

ELM STREET PHARMACY
1010 7TH AVE SW
ALBANY, OR 97321

Pharmacy Comments

Approval Date

4/20/2012

Contract Begin Date

4/20/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/14/2015
Agreement registered in error

Covered Entity Signing Official

Daniel Smith, VP Finance/CFO
(541) 768-5390

Contract Pharmacy Representative

Good Samaritan Regional Medical Center
Penny Reher, Chief Pharmacy Officer
(541) 768-6177

Signed By Date

4/27/2012