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LAKE CHELAN PHARMACY INC
CAH501334-00 LAKE CHELAN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
LAKE CHELAN COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501334-00
Entity Address
110 S Apple Blossom Dr.
CHELAN, WA 98816
Medicare Provider Number
501334
Participating Start Date
1/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
LAKE CHELAN PHARMACY INC
Pharmacy Address
LAKE CHELAN PHARMACY, INC.
223 E JOHNSON AVE
LAKE CHELAN PHARMACY INC
CHELAN, WA 98816-9160
Pharmacy Comments
Contract Details
Approval Date
12/23/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/4/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Kevin Abel, Chief Executive Officer
(509) 682-8503
Contract Pharmacy Representative
Paul Volkman, Owner
(509) 682-2751
Signed By Date
12/23/2015
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