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WAL-MART PHARMACY 10-1772
DSH380047 St. Charles Health System, Inc., d/b/a St. Charles Bend
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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
WAL-MART PHARMACY 10-1772
Pharmacy Address
3600 WASHBURN WAY
KLAMATH FALLS, OR 97603
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
11/28/2016
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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