340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1772
DSH380050 Sky Lakes Medical Center
Print
Covered Entity Details
Entity Name
Sky Lakes Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380050
Entity Address
2865 Daggett Avenue
Klamath Falls, OR 97601
Medicare Provider Number
380050
Participating Start Date
7/1/2012
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1772
Pharmacy Address
3600 WASHBURN WAY
KLAMATH FALLS, OR 97603
Pharmacy Comments
Contract Details
Approval Date
10/9/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/2/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard E. Rico, Vice President/CFO
(541) 274-6150
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/9/2014
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