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PEACEHEALTH OREGON REGION
CAH381301-00 COTTAGE GROVE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
COTTAGE GROVE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381301-00
Entity Address
1515 VILLAGE DRIVE
COTTAGE GROVE, OR 97424-9700
Medicare Provider Number
381301
Participating Start Date
4/1/2017
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
PEACEHEALTH OREGON REGION
Pharmacy Address
123 International Way
Springfield, OR 97477
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
9/8/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
Mary Anne McMurren, Interim COO
(514) 338-1656
Contract Pharmacy Representative
Wendy Apland, CFO
(541) 222-2007
Signed By Date
8/15/2011
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