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CREDENA HEALTH, LLC
CAH501326-00 Providence Mount Carmel Hospital
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Covered Entity Details
Entity Name
Providence Mount Carmel Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501326-00
Entity Address
982 E Columbia Ave
Colville, WA 99114
Medicare Provider Number
501326
Participating Start Date
10/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH, LLC
Pharmacy Address
6348 NE HALSEY ST
SUITE A
PORTLAND, OR 97213-4720
Pharmacy Comments
Contract Details
Approval Date
10/9/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Helen Andrus, CFO
(509) 474-3307
Contract Pharmacy Representative
Debbie Michaelson, Director of Specialty Pharmacy Svcs
(503) 962-1700
Signed By Date
10/9/2015
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