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MEDICINE SHOPPE PHARMACY #106
CAH501336-00 MASON GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MASON GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501336-00
Entity Address
901 Mountain View Drive
SHELTON, WA 98584
Medicare Provider Number
501336
Participating Start Date
4/1/2016
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MEDICINE SHOPPE PHARMACY #106
Pharmacy Address
207 PROFESSIONAL WAY
SHELTON, WA 98584-4404
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rick Donald Smith, Chief Financial Officer
(360) 432-3260
Contract Pharmacy Representative
St Mark Enterprises
Rik St. Germain, Owner
(206) 650-5541
Signed By Date
7/13/2016
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