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HOME TOWN DRUGS OF PRINEVILLE, INC
CAH381313-00 St. Charles Health System, Inc., d/b/a St. Charles Prineville
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Covered Entity Details
Entity Name
St. Charles Health System, Inc., d/b/a St. Charles Prineville
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381313-00
Entity Address
384 SE Combs Flat Road
Prineville, OR 97754
Medicare Provider Number
381313
Participating Start Date
7/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
HOME TOWN DRUGS OF PRINEVILLE, INC
Pharmacy Address
DBA: CLINIC PHARMACY
198 NE COMBS FLAT RD, STE. 100
PRINEVILLE, OR 97754
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
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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