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HI-SCHOOL PHARMACY OF OREGON, INC.
CAH381316-00 PeaceHealth DBA Peace Harbor Medical Center
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Covered Entity Details
Entity Name
PeaceHealth DBA Peace Harbor Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381316-00
Entity Address
400 9TH STREET
Attention Pharmacy Services Department
FLORENCE, OR 97439
Medicare Provider Number
381316
Participating Start Date
1/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HI-SCHOOL PHARMACY OF OREGON, INC.
Pharmacy Address
DBA: FLORENCE PHARMACY #1184
2935 HIGHWAY 101
FLORENCE, OR 97439-9754
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
8/8/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rick Yecny, CAO
(541) 902-6540
Contract Pharmacy Representative
Jack Holt, Pharmacy Director/Owner
(360) 693-5879
Signed By Date
7/15/2011
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