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FRED MEYER INC
CAH381320-00 Columbia Lutheran Charities DBA Columbia Memorial Hospital
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Covered Entity Details
Entity Name
Columbia Lutheran Charities DBA Columbia Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381320-00
Entity Address
2111 Exchange Street
Astoria, OR 97103-3329
Medicare Provider Number
381320
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
FRED MEYER INC
Pharmacy Address
DBA FRED MEYER
695 HWY 101
WARRENTON, OR 97146
Pharmacy Comments
Contract Details
Approval Date
10/1/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephanie Brenden, VP of Finance
(503) 338-4517
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/1/2015
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