340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WILSON DRUG INCORPORATED
CAH381317-01 NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER
Print
Covered Entity Details
Entity Name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER
Subdivision Name
TILLAMOOK MEDICAL GROUP
Type
Critical Access Hospital
340B ID
CAH381317-01
Entity Address
1100 THIRD STREET
TILLAMOOK, OR 97141
Medicare Provider Number
381317
Outpatient Facility Provider Number
388504
Participating Start Date
1/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WILSON DRUG INCORPORATED
Pharmacy Address
DBA: TILLAMOOK PHARMACY
915 MAIN AVENUE
TILLAMOOK, OR 97141
Pharmacy Comments
Contract Details
Approval Date
8/3/2012
Contract Begin Date
8/3/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2018
Ownership change
Contacts
Covered Entity Signing Official
WALTER LARSON, CFO
(503) 815-2260
Contract Pharmacy Representative
David Wilson, Owner
(503) 842-4181
Signed By Date
8/2/2012
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session