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BLW INC
RRC380047-00 St. Charles Health System, Inc DBA St. Charles Medical Center-Bend
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Covered Entity Details
Entity Name
St. Charles Health System, Inc DBA St. Charles Medical Center-Bend
Subdivision Name
Type
Rural Referral Center
340B ID
RRC380047-00
Entity Address
2500 NE Neff Road
Bend, OR 97701
Medicare Provider Number
380047
Participating Start Date
7/1/2012
Last Recertification Date
8/6/2015
Entity Termination Date
7/1/2016
Pharmacy Details
Pharmacy Name
BLW INC
Pharmacy Address
HOMETOWN DRUGS
65 NE OAK ST STE 100
MADRAS, OR 97741-1814
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Karen Shepard, CFo/Sr. VP
(541) 706-7707
Contract Pharmacy Representative
Lee Land, CEO
(541) 408-4756
Signed By Date
4/12/2013
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