Contract Pharmacy Details

DRUG MART PHARMACY
SCH380040-00 St. Charles Health System, Inc., d/b/a St. Charles Redmond

Covered Entity Details

Entity Name

St. Charles Health System, Inc., d/b/a St. Charles Redmond

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH380040-00

Entity Address

1253 NW Canal Blvd
Redmond, OR 97756

Medicare Provider Number

380040

Participating Start Date

7/1/2012

Last Recertification Date

9/9/2020

Entity Termination Date

10/1/2021

Pharmacy Details

Pharmacy Name

DRUG MART PHARMACY

Pharmacy Address

DRUG MART PHARMACY
51600 HUNTINGTON RD
SUITE A
LA PINE, OR 97739

Pharmacy Comments

Contract Details

Approval Date

4/15/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/7/2016
Business decision by covered entity and/or pharmacy

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

4/15/2013

340B Drug Pricing Program Database