340B Drug Pricing Program Database


CH10123V VIRGINIA GARCIA MEMORIAL HEALTH CENTER (Active) - information as of 5/13/2025 10:55:06 PM

Main Details
VIRGINIA GARCIA MEMORIAL HEALTH CENTER
VIRGINIA GARCIA MEMORIAL HEALTH CENTER- CORNELIUS DENTAL
HRSA-Funded Health Center
BPS-H80-002927
CH10123V
H80CS00817


Additional Details
Active
2/13/2017
4/1/2017
2/24/2017
2/12/2025

Contacts

Virginia Garcia Memorial Health Center
Gil Munoz, CEO
(503) 214-1600

Virginia Garcia Memorial Health Center
April M. Etheridge-Bosworth, Director of Pharmacy
(205) 873-0089

Addresses

44 N 11TH AVE
CORNELIUS, OR 97113-9020

Virginia Garcia Memorial Health Center
PO Box 6149
Aloha, OR 97007


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
OR500645334,298994,006039,241292,241269,670700,5006447311740547694,1811930175,1508876319,1720178783,1861566259,1720403181,1679528012
Shipping Addresses

Virginia Garcia Memorial Health Center
1151 N Adair St
Cornelius, OR 97113
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailWALGREEN CO.DBA: WALGREENS # 09353 115 N 20TH AVE
CORNELIUSOR9711310/13/202301/01/2024  01/01/2024
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH101230ActiveBPS-H80-000991VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINIA GARCIA MEMORIAL HEALTH CENTER - Cornelius1151 N Adair Street CorneliusOR
CH10123AActiveBPS-H80-005012VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINIA GARCIA MEMORIAL HEALTH CENTER- HILLSBORO226 S.E. 8TH AVENUE STE 100 HILLSBOROOR
CH10123AAActiveBPS-H80-038783VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINIA GARCIA MOBILE VAN 21151 N Adair St CorneliusOR
CH10123ABActiveBPS-H80-031313VIRGINIA GARCIA MEMORIAL HEALTH CENTERVirginia Garcia Intermittent Sites1151 N Adair St CorneliusOR
CH10123EActiveBPS-H80-000547VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINIA GARCIA MEMORIAL HEALTH CENTER- MCMINNVILLE115 NE May Ln McminnvilleOR
CH10123GActiveBPS-H80-018305VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINIA GARCIA BEAVERTON WELLNESS CENTER2725 SW CEDAR HILLS BLVD BEAVERTONOR
CH10123HActiveBPS-H80-000015VIRGINIA GARCIA MEMORIAL HEALTH CENTERTigard School Based Health Center9000 SW Durham Rd Bldg 7110 TigardOR
CH10123JActiveBPS-H80-008200VIRGINIA GARCIA MEMORIAL HEALTH CENTERForest Grove School Based Health Center1715 Nichols Ln Forest GroveOR
CH10123KActiveBPS-H80-012098VIRGINIA GARCIA MEMORIAL HEALTH CENTERWillamina School Based Health Center1100 NE Oaken Hills Dr WillaminaOR
CH10123LActiveBPS-H80-012345VIRGINIA GARCIA MEMORIAL HEALTH CENTERHillsboro School-Based Health Center1998 SE Century Blvd HillsboroOR
CH10123MActiveBPS-H80-013168VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINIA GARCIA MEMORIAL HEALTH CENTER- NEWBERG2251 E Hancock St, STE 103 NewbergOR
CH10123NActiveBPS-H80-012866VIRGINIA GARCIA MEMORIAL HEALTH CENTERVirginia Garcia/Lifeworks NW Hillsboro971 SW Walnut St HillsboroOR
CH10123PTerminatedBPS-H80-014738VIRGINIA GARCIA MEMORIAL HEALTH CENTERTualatin School Based Health Center22300 SW BOONES FERRY RD TUALATINOR
CH10123QActiveBPS-H80-014453VIRGINIA GARCIA MEMORIAL HEALTH CENTERVirginia Garcia Beaverton School Based Health Center13000 SW 2ND ST BEAVERTONOR
CH10123RActiveBPS-H80-014152VIRGINIA GARCIA MEMORIAL HEALTH CENTEREvans Street Mental Health Integration Site627 Evans Street Primary Care Clinic McMinnvilleOR
CH10123SActiveBPS-H80-017016VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINIA GARCIA MEMORIAL HEALTH CENTER- NEWBERG DENTAL2251 E Hancock St., Suite 106 NewbergOR
CH10123TActiveBPS-H80-013746VIRGINIA GARCIA MEMORIAL HEALTH CENTERVirginia Garcia Beaverton Dental Clinic12600 SW CRESCENT ST BEAVERTONOR
CH10123UActiveBPS-H80-005418VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINA GARCIA MEMORIAL HEALTH CENTER- HILLSBORO DENTAL730 SE Oak St HillsboroOR
CH10123VActiveBPS-H80-002927VIRGINIA GARCIA MEMORIAL HEALTH CENTERVIRGINIA GARCIA MEMORIAL HEALTH CENTER- CORNELIUS DENTAL44 N 11TH AVE CORNELIUSOR
CH10123WActiveBPS-H80-019384Virginia Garcia Memorial Health CenterVirginia Garcia Reproductive Health Clinic333 SE 7th Ave, Suite 5500 HillsboroOR
CH10123XActiveBPS-H80-005940Virginia Garcia Memorial Health CenterVIRGINIA GARCIA MOBILE VAN1151 N. Adair St CORNELIUSOR
CH10123YActiveBPS-H80-022054Virginia Garcia Memorial Health CenterVirginia Garcia/LifeWorks NW Beaverton10700 SW Beaverton Hillsdale Hwy Bldg 1 BeavertonOR
CH10123ZActiveBPS-H80-034519Virginia Garcia Memorial Health CenterVirginia Garcia Memorial Health Center - Hillsboro 7th Avenue232 SE 7th Ave HillsboroOR
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH101230ALBERTSONS LLCSAV-ON PHARMACY #2528 615 SW KECK DRIVE
MCMINNVILLEOR9712804/01/2019  
CH10123KALBERTSONS LLCSAV-ON PHARMACY #2528 615 SW KECK DRIVE
MCMINNVILLEOR9712801/01/2024  
CH101230CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/01/2022  
CH101230CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/01/2022  
CH101230CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/01/2022  
CH101230CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/01/2022  
CH101230CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/01/2022  
CH101230CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/01/2022  
CH101230CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/01/2022  
CH101230CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/01/2022  
CH101230CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/01/2022  
CH101230CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/01/2022  
CH101230CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2022  
CH101230CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2022  
CH101230CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2022  
CH101230CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/01/2019  
CH101230EVERGREEN PHARMACEUTICAL,LLCDBA OMNICARE OF PORTLAND 11933 NE GLENN WIDING DR
PORTLANDOR97220-909901/01/2023  
CH101230FRED MEYER11425 S.W. BEAVERTON HILLSDALE
BEAVERTONOR9700507/01/2019  
CH101230FRED MEYER INCPHARMACY DEPARTMENT 2200 BASE LINE STREET
CORNELIUSOR9711307/01/2019  
CH101230FRED MEYER INC3300 PORTLAND ROAD
NEWBERGOR9713207/01/2019  
CH101230FRED MEYER INCDBA FRED MEYER 15995 S.W. WALKER ROAD
BEAVERTONOR97006-494407/01/2019  
CH10123TFRED MEYER INCDBA FRED MEYER 15995 S.W. WALKER ROAD
BEAVERTONOR97006-494401/01/2024  
CH101230FRED MEYER PHARMACY6495 SE TUALATIN VALLEY HWY
HILLSBOROOR9712307/01/2019  
CH10123NFRED MEYER PHARMACY6495 SE TUALATIN VALLEY HWY
HILLSBOROOR9712301/01/2024  
CH101230HEALTHY OPTIONS INCDBA POSTAL PRESCRIPTION SVCS 3500 SE 26TH AVE
PO BOX 2718
PORTLANDOR9720207/01/2019  
CH101230OREGON CVS PHARMACY, L.L.C.CVS PHARMACY # 16126 9009 SW HALL BLVD
TIGARDOR9722307/01/2022  
CH101230OREGON CVS PHARMACY, L.L.C.CVS/PHARMACY # 11150 12555 NW CORNELL RD
PORTLANDOR9722907/01/2022  
CH101230OREGON CVS PHARMACY, L.L.C.CVS PHARMACY # 16125 10775 SW BEAVERTON HILLSDALE HWY
BEAVERTONOR9700507/01/2022  
CH101230OREGON CVS PHARMACY, L.L.C.CVS PHARMACY # 16988 21365 SW BALER WAY
SHERWOODOR9714007/01/2022  
CH101230OREGON CVS PHARMACY, L.L.C.CVS PHARMACY # 16140 2295 SE TUALATIN VALLEY HWY
HILLSBOROOR9712307/01/2022  
CH101230OREGON CVS PHARMACY, L.L.C.CVS PHARMACY # 16336 18101 NW EVERGREEN PKWY
BEAVERTONOR9700607/01/2022  
CH101230PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999204/01/2019 09/30/2022
CH101230PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/01/2022  
CH101230PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/01/2022  
CH101230PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681307/01/2022  
CH101230PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/01/2022  
CH101230PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2819 1309 NW 23RD AVE.
PORTLANDOR9721007/01/2022  
CH10123QPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2819 1309 NW 23RD AVE.
PORTLANDOR9721001/01/2024  
CH101230SAFEWAY INCSAFEWAY PHARMACY #1601 2490 NE HIGHWAY 99W
MCMINNVILLEOR9712804/01/2023  
CH101230SAFEWAY INCSAFEWAY PHARMACY #0406 2836 PACIFIC AVENUE
FOREST GROVEOR9711604/01/2023  
CH101230THRIFTY PAYLESS, INC.RITE AID #5340 448 NE HIGHWAY 99W
MCMINNVILLEOR9712810/01/2019  
CH101230THRIFTY PAYLESS, INC.RITE AID #5338 2425 SE TUALATIN VALLEY HWY.
HILLSBOROOR9712310/01/2019  
CH101230THRIFTY PAYLESS, INC.RITE AID #4064 17495 SW FARMINGTON ROAD
ALOHAOR9700710/01/2019  
CH101230THRIFTY PAYLESS, INC.RITE AID #5339 2021 NW 185TH AVENUE
HILLSBOROOR9712410/01/2019  
CH101230THRIFTY PAYLESS, INC.RITE AID #5321 20225 SW TUALATIN VALLEY HWY
ALOHAOR9700310/01/2019 06/27/2022
CH101230THRIFTY PAYLESS, INC.RITE AID #5353 12240 SW SCHOLLS FERRY ROAD
TIGARDOR9722307/01/2022  
CH10123JTHRIFTY PAYLESS, INC.RITE AID #5340 448 NE HIGHWAY 99W
MCMINNVILLEOR9712801/01/2024  
CH10123YTHRIFTY PAYLESS, INC.RITE AID #4064 17495 SW FARMINGTON ROAD
ALOHAOR9700701/01/2024  
CH10123WTHRIFTY PAYLESS, INC.RITE AID #5339 2021 NW 185TH AVENUE
HILLSBOROOR9712401/01/2024  
CH101230WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2019  
CH101230WAL-MART PHARMACY 10-18432375 NORTH 99 WEST
MCMINNVILLEOR9712804/01/2019  
CH10123HWAL-MART PHARMACY 10-18432375 NORTH 99 WEST
MCMINNVILLEOR9712801/01/2024  
CH101230WAL-MART PHARMACY 10-30509055 SW MURRAY BLVD
BEAVERTONOR9700804/01/2023  
CH101230WAL-MART PHARMACY 10-4221220 N ADAIR
CORNELIUSOR9711304/01/2019  
CH10123XWAL-MART PHARMACY 10-4221220 N ADAIR
CORNELIUSOR9711301/01/2024  
CH101230WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS #15071 13470 NW CORNELL RD
PORTLANDOR97229-565107/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS # 05780 13939 SW PACIFIC HWY
TIGARDOR9722307/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS # 05952 7280 SW BEAVERTON-HILLSDALE HWY
PORTLANDOR9722507/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS # 06370 14600 SW MURRAY SCHOLLS DR #201
BEAVERTONOR9700707/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS # 06664 1840 E PORTLAND RD
NEWBERGOR9713207/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS # 06852 19975 SW TUALATIN VALLEY HWY
ALOHAOR9700307/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS # 07120 603 SW BAKER ST
MCMINNVILLEOR9712807/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS # 09625 17850 LOWER BOONES FERRY RD
LAKE OSWEGOOR9703507/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS #13780 955 SE BASELINE ST.
HILLSBOROOR97123-420707/01/2013 07/16/2015
CH101230WALGREEN CO.DBA: WALGREENS # 06370 14600 SW MURRAY SCHOLLS DR #201
BEAVERTONOR9700704/01/2019  
CH101230WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21151 1215 NW 23RD AVE
PORTLANDOR9721004/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS # 01082 4816 NW BETHANY BLVD
PORTLANDOR97229-925404/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS # 06852 19975 SW TUALATIN VALLEY HWY
ALOHAOR9700304/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS #11719 6215 SE TUALATIN VALLEY HWY.
HILLSBOROOR9712304/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS #13780 955 SE BASELINE ST.
HILLSBOROOR97123-420704/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS # 06831 7010 NE CORNELL ROAD
HILLSBOROOR97124-542204/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS # 06664 1840 E PORTLAND RD
NEWBERGOR9713204/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS # 09353 115 N 20TH AVE
CORNELIUSOR9711304/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS # 07120 603 SW BAKER ST
MCMINNVILLEOR9712804/01/2019  
CH101230WALGREEN CO.DBA: WALGREENS #15403 18470 SW FARMINGTON ROAD
BEAVERTONOR9700704/01/2023  
CH10123UWALGREEN CO.DBA: WALGREENS # 06664 1840 E PORTLAND RD
NEWBERGOR9713201/01/2024  
CH10123ZWALGREEN CO.DBA: WALGREENS # 06852 19975 SW TUALATIN VALLEY HWY
ALOHAOR9700301/01/2024  
CH10123RWALGREEN CO.DBA: WALGREENS # 07120 603 SW BAKER ST
MCMINNVILLEOR9712801/01/2024  
CH10123VWALGREEN CO.DBA: WALGREENS # 09353 115 N 20TH AVE
CORNELIUSOR9711301/01/2024  
CH10123LWALGREEN CO.DBA: WALGREENS #13780 955 SE BASELINE ST.
HILLSBOROOR97123-420701/01/2024  
CH101230WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/01/2019  
CH101230WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/01/2019  
CH101230WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/01/2019  
CH101230WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/01/2019 10/08/2021
CH101230WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/01/2023  
CH101230Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616801/01/2024  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/12/2024 8:28:04 AM2/12/2025 8:43:09 PM2/12/2025 8:43 PM
ContactsPrimary ContactUpdateGroup Change RequestEtheridge-Bosworth, April M. Pharmacy Director Virginia Garcia Memorial Health Center 2058730089Etheridge-Bosworth, April M. Director of Pharmacy Virginia Garcia Memorial Health Center 205873008911/21/2024 9:15 AM
ContactsPrimary ContactUpdateProfile Change RequestHigdon, April E Pharmacy Director Virginia Garcia Memorial Health Center 5033528553Etheridge-Bosworth, April M. Pharmacy Director Virginia Garcia Memorial Health Center 205873008911/12/2024 6:40 AM
AddressesBilling AddressUpdateRecertificationVirginia Garcia Memorial Health Center - Cornelius Dental PO Box 6149 Aloha, OR 97007Virginia Garcia Memorial Health Center PO Box 6149 Aloha, OR 970072/12/2024 8:28 AM
AddressesShipping AddressInsertRecertification Virginia Garcia Memorial Health Center 1151 N Adair St Cornelius, OR 971132/12/2024 8:28 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/12/2024 8:28 AM
Medicaid BillingMedicaid: NumberInsertRecertification 5006447312/12/2024 8:28 AM
Medicaid BillingMedicaid: StateInsertRecertification OR2/12/2024 8:28 AM
Medicaid BillingNPI: NumberInsertRecertification 16795280122/12/2024 8:28 AM
Medicaid BillingNPI: StateInsertRecertification OR2/12/2024 8:28 AM
DetailsLast Recertification DateUpdateRecertification2/23/2023 9:52:13 AM2/12/2024 8:28:04 AM2/12/2024 8:28 AM
ContactsAuthorizing OfficialUpdateGroup Change RequestDennis, Annmarie Rainford Corporate Compliance Officer Virginia Garcia Memorial Health Center 5032141652Munoz, Gil CEO Virginia Garcia Memorial Health Center 50321416001/25/2024 2:35 PM
ContactsSigned ByUpdateChange RequestMunoz, Gil CEO Virginia Garcia Memorial Health Center 5033598503Munoz, Gil CEO Virginia Garcia Memorial Health Center 50321416001/18/2024 12:29 PM
DetailsLast Recertification DateUpdateRecertification2/8/2022 1:59:42 PM2/23/2023 9:52:13 AM2/23/2023 9:52 AM
ContactsPrimary ContactUpdateChange RequestHicks, Christine Pharmacy Director Virginia Garcia Memorial Health Center 5033528553Higdon, April E Pharmacy Director Virginia Garcia Memorial Health Center 50335285539/23/2022 7:28 AM
DetailsLast Recertification DateUpdateRecertification2/7/2021 9:52:52 PM2/8/2022 1:59:42 PM2/8/2022 1:59 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/25/2021 3:00 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2989942/25/2021 3:00 PM
Medicaid BillingMedicaid: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/25/2021 3:00 PM
Medicaid BillingMedicaid: NumberInsertChange Request 0060392/25/2021 3:00 PM
Medicaid BillingMedicaid: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/25/2021 3:00 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2412922/25/2021 3:00 PM
Medicaid BillingMedicaid: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/25/2021 3:00 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2412692/25/2021 3:00 PM
Medicaid BillingMedicaid: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/25/2021 3:00 PM
Medicaid BillingMedicaid: NumberInsertChange Request 6707002/25/2021 3:00 PM
Medicaid BillingMedicaid: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingNPI: NumberInsertChange Request 18119301752/25/2021 3:00 PM
Medicaid BillingNPI: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingNPI: NumberInsertChange Request 15088763192/25/2021 3:00 PM
Medicaid BillingNPI: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingNPI: NumberInsertChange Request 17201787832/25/2021 3:00 PM
Medicaid BillingNPI: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingNPI: NumberInsertChange Request 18615662592/25/2021 3:00 PM
Medicaid BillingNPI: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingNPI: NumberInsertChange Request 17204031812/25/2021 3:00 PM
Medicaid BillingNPI: StateInsertChange Request OR2/25/2021 3:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False2/7/2021 9:52 PM
Medicaid BillingMedicaid: NumberInsertRecertification 5006453342/7/2021 9:52 PM
Medicaid BillingMedicaid: StateInsertRecertification OR2/7/2021 9:52 PM
Medicaid BillingMedicaid: NumberDeleteRecertification023197 (OR) 2/7/2021 9:52 PM
Medicaid BillingNPI: StateUpdateRecertification OR2/7/2021 9:52 PM
DetailsLast Recertification DateUpdateRecertification2/4/2020 2:58:57 PM2/7/2021 9:52:52 PM2/7/2021 9:52 PM
DetailsLast Recertification DateUpdateRecertification1/29/2019 5:36:17 PM2/4/2020 2:58:57 PM2/4/2020 2:58 PM
AddressesBilling AddressInsertRecertification Virginia Garcia Memorial Health Center - Cornelius Dental PO Box 6149 Aloha, OR 970071/29/2019 5:36 PM
DetailsLast Recertification DateUpdateRecertification3/1/2018 2:50:47 PM1/29/2019 5:36:17 PM1/29/2019 5:36 PM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 1/29/2019 5:36 PM
ContactsAuthorizing OfficialUpdateAO Change RequestMunoz, Gil CEO Virginia Garcia Memorial Health Center 5033598503Dennis, Annmarie Rainford Corporate Compliance Officer Virginia Garcia Memorial Health Center 50321416521/29/2019 7:53 AM
DetailsLast Recertification DateUpdateRecertification 3/1/2018 2:50:47 PM3/1/2018 2:50 PM
ContactsAuthorizing OfficialUpdate Munoz, Gil CEO 5033598503Munoz, Gil CEO Virginia Garcia Memorial Health Center 50335985031/9/2018 5:55 PM
ContactsSigned ByUpdate Munoz, Gil CEO 5033598503Munoz, Gil CEO Virginia Garcia Memorial Health Center 50335985031/9/2018 5:55 PM
ContactsPrimary ContactUpdate Hicks, Christine Pharmacy Director 5033528553Hicks, Christine Pharmacy Director Virginia Garcia Memorial Health Center 50335285539/26/2017 2:18 PM
AddressesMain AddressInsert   44 N 11TH AVE CORNELIUS, OR 97113-90203/16/2017 11:54 AM
ContactsAuthorizing OfficialInsert  Munoz, Gil CEO 50335985033/16/2017 11:54 AM
ContactsSigned ByInsert  Munoz, Gil CEO 50335985033/16/2017 11:54 AM
ContactsPrimary ContactInsert  Hicks, Christine Pharmacy Director 50335285533/16/2017 11:54 AM
DatesParticipating Approval DateUpdate  2/24/2017 12:00:00 AM2/24/2017 5:57 PM
DetailsStateUpdate PendingActive2/24/2017 5:57 PM
DatesStart DateUpdate  4/1/2017 12:00:00 AM2/24/2017 5:57 PM
Details340B IDUpdate ONLINE_REG_75654CH10123V2/14/2017 3:19 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_756542/13/2017 11:26 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False2/13/2017 11:26 PM
Medicaid BillingMedicaid: NumberInsert  0231972/13/2017 11:26 PM
Medicaid BillingMedicaid: StateInsert  OR2/13/2017 11:26 PM
Medicaid BillingNPI: NumberInsert  17405476942/13/2017 11:26 PM
DetailsLast Recertification DateInsert   2/13/2017 11:26 PM
DetailsGrant NumberInsert  H80CS008172/13/2017 11:26 PM
Details340B IDInsert  ONLINE_REG2/13/2017 11:26 PM
DetailsIs Authorizing Official EHB DataInsert  False2/13/2017 11:26 PM
DatesLast Date That 340B Drugs PurchasedInsert   2/13/2017 11:26 PM
DetailsMedicare Provider NumberInsert   2/13/2017 11:26 PM
DetailsEntity NameInsert  VIRGINIA GARCIA MEMORIAL HEALTH CENTER2/13/2017 11:26 PM
DetailsProgram CodeInsert  CH2/13/2017 11:26 PM
DetailsEntity SubnameInsert  VIRGINIA GARCIA MEMORIAL HEALTH CENTER- CORNELIUS DENTAL2/13/2017 11:26 PM
DatesParticipating Approval DateInsert   2/13/2017 11:26 PM
DetailsStateInsert  Pending2/13/2017 11:26 PM
DatesRegistration DateInsert  2/13/2017 12:00:00 AM2/13/2017 11:26 PM
DatesSigned By DateInsert  2/13/2017 12:00:00 AM2/13/2017 11:26 PM
DatesStart DateInsert   2/13/2017 11:26 PM
TerminationsTermination CommentsInsert   2/13/2017 11:26 PM
TerminationsTermination DateInsert   2/13/2017 11:26 PM
TerminationsTermination Effective DateInsert   2/13/2017 11:26 PM
TerminationsTermination ReasonInsert   2/13/2017 11:26 PM