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WAL-MART PHARMACY 10-2243
CAH381324-00 St. Charles Health System, Inc., d/b/a St. Charles Madras
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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
WAL-MART PHARMACY 10-2243
Pharmacy Address
300 NW OAK TREE LANE
REDMOND, OR 97756
Pharmacy Comments
Contract Details
Approval Date
7/1/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/10/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Rue Welander, Chief Financial Officer
(541) 706-7707
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
7/1/2016
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