Contract Pharmacy Details

TRI-AREA PHARMACY LLC
CAH501323-00 JEFFERSON HEALTHCARE

Covered Entity Details

Entity Name

JEFFERSON HEALTHCARE

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH501323-00

Entity Address

834 Sheridan St
Port Townsend, WA 98368

Medicare Provider Number

501323

Participating Start Date

1/1/2011

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

TRI-AREA PHARMACY LLC

Pharmacy Address

65 OAK BAY RD
PORT HADLOCK, WA 98339-1176

Pharmacy Comments

Contract Details

Approval Date

10/16/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2015
Ownership change

Contacts

Covered Entity Signing Official

Hilary Whittington, CFO
(360) 385-2200 Ext: 2094

Contract Pharmacy Representative

Renaldo Genir, Owner
(360) 379-9800

Signed By Date

10/16/2014