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WHITE CROSS PHARMACY - PRIEST RIVER
CAH501310-00 Pend Oreille County Public Hospital District #1 DBA Newport Community Hospital
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Covered Entity Details
Entity Name
Pend Oreille County Public Hospital District #1 DBA Newport Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501310-00
Entity Address
714 W. Pine Street
Newport, WA 99156
Medicare Provider Number
501310
Participating Start Date
10/1/2012
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WHITE CROSS PHARMACY - PRIEST RIVER
Pharmacy Address
5453 HIGHWAY 2
PO BOX 458
PRIEST RIVER, ID 83856
Pharmacy Comments
Contract Details
Approval Date
10/19/2012
Contract Begin Date
10/19/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Manus, CFO
(509) 447-2441 Ext: 4226
Contract Pharmacy Representative
Deblaquiere ENT. INC.
Richard De Blaquiere, OWNER/PHARMACIST
(208) 448-1633
Signed By Date
10/1/2012
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