Contract Pharmacy Details

SHOPKO PHARMACY #2093
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

SHOPKO PHARMACY #2093

Pharmacy Address

60 NE BEND RIVER MALL AVE
BEND, OR 97701

Pharmacy Comments

Contract Details

Approval Date

7/18/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/28/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jennifer Rue Welander, Chief Financial Officer
(541) 706-7707

Contract Pharmacy Representative

ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726

Signed By Date

7/18/2017

340B Drug Pricing Program Database