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SHOPKO PHARMACY #2134
CAH501327-00 Whitman Hospital and Medical Center
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Covered Entity Details
Entity Name
Whitman Hospital and Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501327-00
Entity Address
1200 West Fairview
Colfax, WA 99111
Medicare Provider Number
501327
Participating Start Date
7/1/2012
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2134
Pharmacy Address
SOUTH 1450 GRAND AVENUE
PULLMAN, WA 99163
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/27/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Pamela Akin, CNO
(509) 288-9741
Contract Pharmacy Representative
Shopko Pharmacy
Debi Danbury, 340B Program Manager
(920) 429-7613
Signed By Date
1/12/2018
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