Contract Pharmacy Details

BLW INC
DSH380047 St. Charles Health System, Inc., d/b/a St. Charles Bend

Covered Entity Details

Entity Name

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

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH380047

Entity Address

2500 NE NEFF ROAD
BEND, OR 97701

Medicare Provider Number

380047

Participating Start Date

7/1/2016

Last Recertification Date

8/12/2024

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

6/8/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/19/2016
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

Lee Land, CEO
(541) 408-4756

Signed By Date

6/8/2016

340B Drug Pricing Program Database