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WAL-MART PHARMACY 10-2243
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
WAL-MART PHARMACY 10-2243
Pharmacy Address
300 NW OAK TREE LANE
REDMOND, OR 97756
Pharmacy Comments
Contract Details
Approval Date
7/1/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2016
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
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/1/2016
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