Contract Pharmacy Details

BLW INC
CAH381324-00 St. Charles Health System, Inc., d/b/a St. Charles Madras

Covered Entity Details

Entity Name

St. Charles Health System, Inc., d/b/a St. Charles Madras

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH381324-00

Entity Address

470 NE A Street
Madras, OR 97741

Medicare Provider Number

381324

Participating Start Date

10/1/2013

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

BLW INC

Pharmacy Address

HOMETOWN DRUGS
65 NE OAK ST STE 100
MADRAS, OR 97741-1814

Pharmacy Comments

Contract Details

Approval Date

4/15/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/4/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Karen Shepard, CFo/Sr. VP
(541) 706-7707

Contract Pharmacy Representative

Lee Land, CEO
(541) 408-4756

Signed By Date

4/15/2014

340B Drug Pricing Program Database