Contract Pharmacy Details

WALGREEN CO.
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

WALGREEN CO.

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #16403
1409 11TH AVE.
SEATTLE, WA 98122

Pharmacy Comments

Contract Details

Approval Date

7/5/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/15/2020
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

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/5/2017

340B Drug Pricing Program Database