340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
CAMP RILEY DRUG INC DBA PHARMASAVE MONRO
DSH500084 EVERGREEN HEALTH MONROE
Print
Covered Entity Details
Entity Name
EVERGREEN HEALTH MONROE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500084
Entity Address
14701 179TH SE
MONROE, WA 98272-0646
Medicare Provider Number
500084
Participating Start Date
1/1/2017
Last Recertification Date
8/24/2018
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
CAMP RILEY DRUG INC DBA PHARMASAVE MONRO
Pharmacy Address
17788 147TH ST SE
MONROE, WA 98272
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dale Scott Olander, Chief Financial Officer
(360) 794-1446
Contract Pharmacy Representative
CAMP RILEY DRUG INC DBA PHARMASAVE MONRO
Bridgett Edgar, Vice President
(360) 794-4641
Signed By Date
4/13/2018
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session