Contract Pharmacy Details

DRUG MART PHARMACY
CAH381313-00 St. Charles Health System, Inc., d/b/a St. Charles Prineville

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

DRUG MART PHARMACY

Pharmacy Address

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

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

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

4/12/2013

340B Drug Pricing Program Database