Contract Pharmacy Details

BI-MART CORP
CAH381321-00 Grande Ronde Hospital, Inc.

Covered Entity Details

Entity Name

Grande Ronde Hospital, Inc.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH381321-00

Entity Address

900 Sunset Drive
La Grande, OR 97850

Medicare Provider Number

381321

Participating Start Date

4/1/2013

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

BI-MART CORP

Pharmacy Address

BI-MART PHCY #637
2510 ADAMS AVE
LA GRANDE, OR 97850

Pharmacy Comments

Contract Details

Approval Date

4/2/2015

Contract Begin Date

7/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/3/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Wade E. Weis, Sr. Director of Finance/CFO
(541) 963-1463

Contract Pharmacy Representative

John Dickson, Pharmacy Systems Manager
(541) 868-1762

Signed By Date

4/2/2015

340B Drug Pricing Program Database