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WELLPARTNER, INC
CAH381304-00 SOUTHERN COOS GENERAL HOSPITAL
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Covered Entity Details
Entity Name
SOUTHERN COOS GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381304-00
Entity Address
900 11TH STREET SE
BANDON, OR 97411
Medicare Provider Number
381304
Participating Start Date
10/1/2015
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WELLPARTNER, INC
Pharmacy Address
20800 SW 115TH AVE
SUITE 100
TUALATIN, OR 97062
Pharmacy Comments
Contract Details
Approval Date
11/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/16/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
JoDee Tittle, CEO
(541) 297-3434 Ext: 114
Contract Pharmacy Representative
Wellpartner
Harish Thiagaraj, Senior Vice President Pharmacy Operations
(503) 660-8560
Signed By Date
11/16/2017
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