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ST JOHN PHARMACY
CAH501327-00 Whitman Hospital and Medical Center
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Covered Entity Details
Entity Name
Whitman Hospital and Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501327-00
Entity Address
1200 West Fairview
Colfax, WA 99111
Medicare Provider Number
501327
Participating Start Date
7/1/2012
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ST JOHN PHARMACY
Pharmacy Address
ST JOHN PHARMACY
10 E FRONT ST
SAINT JOHN, WA 99171
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/12/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jim Heilsberg, CFO
(509) 397-3435 Ext: 312
Contract Pharmacy Representative
Michele Welch, owner
(509) 648-3430
Signed By Date
10/14/2014
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