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WALGREENS MAIL SERVICE, INC.
CAH381317-00 NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381317-00
Entity Address
1000 3RD STREET
TILLAMOOK, OR 97141
Medicare Provider Number
381317
Participating Start Date
9/30/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREENS MAIL SERVICE, INC.
Pharmacy Address
8337 S PARK CIRCLE
ORLANDO, FL 32819-9049
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/8/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
WALTER LARSON, CFO
(503) 815-2260
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2015
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