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HUTTULA ENTERPRISES, INC
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
HUTTULA ENTERPRISES, INC
Pharmacy Address
DBA MCCLEARY HEALTHMART PHARMACY
115 W SIMPSON AVE
PO BOX 88
MCCLEARY, WA 98557
Pharmacy Comments
Contract Details
Approval Date
4/4/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Will S. Callicoat, CFO
(360) 346-2246
Contract Pharmacy Representative
Tom Huttula, Owner
(360) 482-2442
Signed By Date
4/4/2016
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