Covered Entity Details

CH10310J Umpqua Community Health Center, Inc., dba Aviva Health (Active) - information as of 5/6/2025 12:04:54 AM

Main Details

Name

Umpqua Community Health Center, Inc., dba Aviva Health

Subdivision Name

UMPQUA COMM HLTH CTR @ DRAIN

Type

HRSA-Funded Health Center

Site ID

BPS-H80-027791

340B ID

CH10310J

Grant Number

H80CS00567

Additional Details

Current Program Status

Active

Registration Date

5/29/2019

Participating Start Date

7/1/2019

Participating Approval Date

5/30/2019

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Umpqua Community Health Center, Inc., dba Aviva Health
Leah Woods, Chief Financial Officer
(541) 672-9596 Ext: 120

Primary Contact

Umpqua Community Health Center
Shannon Davis, 340B Program Manager
(541) 672-9596 Ext: 403

Addresses

Street Address

316 W. A STREET
DRAIN, OR 97435-0158

Billing Address

UMPQUA COMMUNITY HEALTH CENTER, Inc., dba Aviva Health
150 NE KENNETH FORD DR
ROSEBURG, OR 97470

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OR	168395	1649469909

Shipping Addresses

Shipping Address 1

Umpqua Community Health Center, Inc., dba Aviva Health
150 NE Kenneth Ford Drive
Roseburg, OR 97470

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH103100	Active	BPS-H80-008886	UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health	Umpqua Community Health Center	150 NE Kenneth Ford Drive	Roseburg	OR
CH10310B	Active	BPS-H80-004003	UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health	ROSEBURG HIGH SCHOOL	400 W Harvard Ave	Roseburg	OR
CH10310E	Active	BPS-H80-007034	UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health	GLIDE CLINIC	20170 NORTH UMPQUA HIGHWAY	GLIDE	OR
CH10310F	Active	BPS-H80-007926	UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health	Myrtle Creek Clinic	790 S Main St	Myrtle Creek	OR
CH10310G	Terminated	BPS-H80-008205	UMPQUA COMMUNITY HEALTH CENTER, INC	Douglas High School	1381 NW Douglas Avenue	Winston	OR
CH10310H	Active	BPS-H80-038341	UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health	Sutherlin Clinic	775 Taylor Street	Sutherlin	OR
CH10310J	Active	BPS-H80-027791	Umpqua Community Health Center, Inc., dba Aviva Health	UMPQUA COMM HLTH CTR @ DRAIN	316 W. A STREET	DRAIN	OR
CH10310K	Active	BPS-H80-032344	Umpqua Community Health Center, Inc.	Mobile Unit 41	150 NE Kenneth Ford Dr	Roseburg	OR
CH10310L	Terminated	BPS-H80-032345	Umpqua Community Health Center, Inc.	Roseburg Vaccination Clinic	4221 NE Stephens St Ste 101	Roseburg	OR
CH10310M	Terminated	BPS-H80-032346	Umpqua Community Health Center, Inc.	Aviva Health Newton Creek Clinic	3031 NE Stephens St. STE 600, 900	Roseburg	OR
CH10310N	Active	BPS-H80-032347	Umpqua Community Health Center, Inc.	Mobile Unit 24	150 NE Kenneth Ford Dr	Roseburg	OR
CH10310P	Active	BPS-H80-028038	Umpqua Community Health Center, Inc.	UCHC Denture Lab	1423 NW Fairmount St	Roseburg	OR
CH10310Q	Active	BPS-H80-030102	Umpqua Community Health Center, Inc.	Myrtle Creek Dental Clinic	244 NE Division St	Myrtle Creek	OR

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH103100	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2021
CH103100	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2021
CH103100	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2021
CH103100	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/01/2021
CH103100	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2021
CH103100	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2021
CH103100	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
CH103100	ALBERTSONS LLC	SAV-ON PHARMACY #515	3013 NW STEWART PARKWAY	ROSEBURG	OR	97471	01/01/2017
CH103100	APOLLO PHARMACY GROUP, INC.	DBA SUTHERLIN DRUG	113 E. CENTRAL AVE.	SUTHERLIN	OR	97479	08/18/2023
CH10310H	APOLLO PHARMACY GROUP, INC.	DBA SUTHERLIN DRUG	113 E. CENTRAL AVE.	SUTHERLIN	OR	97479	01/01/2024
CH103100	ARDON HEALTH, LLC	11835 NE GLENN WIDING DR		PORTLAND	OR	97220-9057	10/01/2021
CH103100	BIOLOGICS, INC.	BIOLOGICS BY MCKESSON	11800 WESTON PARKWAY	CARY	NC	27513	07/01/2021	01/25/2024
CH103100	BIOPLUS SPECIALTY INFUSION CA, LLC	19110 VAN NESS AVE.		TORRANCE	CA	90501	10/01/2022	09/20/2024
CH103100	BIOPLUS SPECIALTY PHARMACY CA	7373 LINCOLN WAY		GARDEN GROVE	CA	92841	10/01/2022	09/20/2024
CH103100	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	10/01/2022	09/20/2024
CH103100	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2021
CH103100	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2021
CH103100	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2021
CH103100	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2021
CH103100	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2021
CH103100	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2021
CH103100	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2021
CH103100	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2021
CH103100	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2021
CH103100	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2021
CH103100	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2021
CH103100	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2021
CH103100	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2021
CH103100	DAHISSE INC	DBA MYRTLE DRUGS	821 S MAIN ST	MYRTLE CREEK	OR	97457	01/07/2022
CH10310F	DAHISSE INC	DBA MYRTLE DRUGS	821 S MAIN ST	MYRTLE CREEK	OR	97457	01/01/2024
CH103100	DIPLOMAT SPECIALTY PHARMACY	G3320 BEECHER RD		FLINT	MI	48532-3614	10/01/2013	02/01/2017
CH103100	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	10/01/2013	02/01/2017
CH103100	DIPLOMAT SPECIALTY PHARMACY	1370 BUSCH PKWY		BUFFALO GROVE	IL	60089-4505	10/01/2013	02/01/2017
CH103100	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	10/27/2020
CH103100	DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER	DIPLOMAT SPECIALTY PHARMACY	15471 SW 12TH ST STE 207	SUNRISE	FL	33326	10/01/2013	02/01/2017
CH103100	DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN	DIPLOMAT SPECIALTY PHARMACY	1809 EXCISE AVENUE SUITE 204-208	ONTARIO	CA	91761	10/01/2013	02/01/2017
CH103100	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2021
CH103100	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2021
CH103100	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2021
CH103100	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2021
CH103100	FRED MEYER STORES INC	FRED MEYER PHARMACY #281	929 NW GARDEN VALLEY BLVD	ROSEBURG	OR	97471	07/01/2021
CH103100	GORDON'S PHARMACY AND GIFTS, LLC	314 S MAIN ST		CANYONVILLE	OR	97417-9645	01/01/2014
CH103100	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	10/01/2021
CH103100	HOME TOWN DRUGS OF SUTHERLIN INC	DBA: SUTHERLIN DRUG	113 E CENTRAL AVE	SUTHERLIN	OR	97479-9556	04/01/2021	07/05/2023
CH103100	HOMETOWN DRUGS OF ROSEBURG INC	1813 W HARVARD STREET	SUITE 210	ROSEBURG	OR	97471	02/24/2009	12/19/2023
CH10310B	HOMETOWN DRUGS OF ROSEBURG INC	1813 W HARVARD STREET	SUITE 210	ROSEBURG	OR	97471	02/24/2009
CH10310E	HOMETOWN DRUGS OF ROSEBURG INC	1813 W HARVARD STREET	SUITE 210	ROSEBURG	OR	97471	02/24/2009
CH10310F	HOMETOWN DRUGS OF ROSEBURG INC	1813 W HARVARD STREET	SUITE 210	ROSEBURG	OR	97471	04/01/2009
CH103100	HOMETOWN DRUGS OF ROSEBURG INC	1813 W HARVARD STREET	SUITE 210	ROSEBURG	OR	97471	10/01/2024
CH103100	J & I BLACK	DBA SUTHERLIN DRUG	113 EAST CENTRAL AVENUE	SUTHERLIN	OR	97479	04/01/2015	03/23/2017
CH103100	KMART PHARMACY #7580		2757 NW STEWART PARKWAY	ROSEBURG	OR	97471	04/01/2017	06/20/2017
CH103100	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/04/2022
CH103100	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/27/2020
CH103100	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	10/27/2020
CH103100	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/27/2020
CH103100	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	10/27/2020
CH103100	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2021
CH103100	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2819	1309 NW 23RD AVE.	PORTLAND	OR	97210	07/01/2021
CH103100	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2021
CH103100	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2021
CH103100	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/01/2021
CH103100	SAFEWAY INC	SAFEWAY PHARMACY #1666	1539 NE STEPHENS ST	ROSEBURG	OR	97470	07/01/2014
CH103100	SAFEWAY INC	SAFEWAY PHARMACY #4904	821 SOUTH MAIN STREET	MYRTLE CREEK	OR	97457	07/01/2014	08/31/2021
CH103100	THRIFTY PAYLESS, INC.	RITE AID #5382	444 STEPHENS STREET, S.E.	ROSEBURG	OR	97470	01/01/2020	06/08/2023
CH103100	THRIFTY PAYLESS, INC.	RITE AID #5380	1430 NW GARDEN VALLEY BLVD	ROSEBURG	OR	97471	01/01/2020
CH103100	US BIOSERVICES	US BIOSERVICE CORPORATION	5025 PLANO PARKWAY STE 100	CARROLLTON	TX	75010	01/01/2017	04/22/2022
CH103100	US BIOSERVICES	PHARM PLUS ACQUISITION, INC.	5100 E HUNTER AVE SUITE 101	ANAHEIM	CA	92807-2049	01/01/2017	04/22/2022
CH103100	VALLEY DRUGS, INC.	250 NW MAIN ST		WINSTON	OR	97496	10/01/2022
CH103100	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017
CH103100	WAL-MART PHARMACY 10-2477	2125 NW STEWART PKWY		ROSEBURG	OR	97471	04/01/2013
CH10310E	WAL-MART PHARMACY 10-2477	2125 NW STEWART PKWY		ROSEBURG	OR	97471	01/01/2024
CH103100	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2020
CH103100	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017
CH103100	WALGREEN CO.	DBA: WALGREENS #12068	1377 NE STEPHENS ST.	ROSEBURG	OR	97470	04/01/2022
CH103100	WALGREEN CO.	DBA: WALGREENS #13819	1236 NW GARDEN VALLEY BLVD.	ROSEBURG	OR	97471-1925	04/01/2022
CH103100	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21151	1215 NW 23RD AVE	PORTLAND	OR	97210	04/01/2022
CH103100	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2024
CH103100	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2024
CH103100	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2024
CH103100	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH103100	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/12/2024 12:31:05 PM	2/12/2025 2:20:21 PM	2/12/2025 2:20 PM
Details	Last Recertification Date	Update	Recertification	2/1/2023 10:09:10 AM	2/12/2024 12:31:05 PM	2/12/2024 12:31 PM
Contacts	Authorizing Official	Update	Profile Change Request	Hamilton, Leah Chief Financial Officer Umpqua Community Health Center, Inc., dba Aviva Health 5416729596-120	Woods, Leah Chief Financial Officer Umpqua Community Health Center, Inc., dba Aviva Health 5416729596-120	8/7/2023 4:33 PM
Details	Last Recertification Date	Update	Recertification	2/1/2022 10:18:45 AM	2/1/2023 10:09:10 AM	2/1/2023 10:09 AM
Details	Last Recertification Date	Update	Recertification	2/2/2021 5:15:32 PM	2/1/2022 10:18:45 AM	2/1/2022 10:18 AM
Contacts	Authorizing Official	Update	Group Change Request	Bolton, KC CEO Umpqua Community Health Center 5416729596-103	Hamilton, Leah Chief Financial Officer Umpqua Community Health Center, Inc., dba Aviva Health 5416729596-120	8/6/2021 6:30 AM
Addresses	Shipping Address	Delete	Change Request	Umpqua Community Health Center 150 Kenneth Ford Drive Roseburg, OR 97470		6/17/2021 5:11 PM
Addresses	Billing Address	Update	Change Request	UMPQUA COMMUNITY HEALTH CENTER 150 NE KENNETH FORD DR ROSEBURG, OR 97470	UMPQUA COMMUNITY HEALTH CENTER, Inc., dba Aviva Health 150 NE KENNETH FORD DR ROSEBURG, OR 97470	6/17/2021 5:11 PM
Addresses	Shipping Address	Insert	Change Request		Umpqua Community Health Center, Inc., dba Aviva Health 150 NE Kenneth Ford Drive Roseburg, OR 97470	6/17/2021 5:11 PM
Addresses	Billing Address	Update	Change Request	UMPQUA COMMUNITY HEALTH CENTER 150 KENNETH FORD DR ROSEBURG, OR 97470	UMPQUA COMMUNITY HEALTH CENTER 150 NE KENNETH FORD DR ROSEBURG, OR 97470	5/24/2021 1:02 PM
Details	Entity Name	Update	Change Request	Umpqua Community Health Center, Inc	Umpqua Community Health Center, Inc., dba Aviva Health	5/24/2021 1:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649469909 ( )		2/2/2021 5:15 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1649469909	2/2/2021 5:15 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/2/2021 5:15 PM
Details	Last Recertification Date	Update	Recertification	2/6/2020 10:51:22 AM	2/2/2021 5:15:32 PM	2/2/2021 5:15 PM
Details	Last Recertification Date	Update	Recertification		2/6/2020 10:51:22 AM	2/6/2020 10:51 AM
Terminations	Termination Reason	Update		At request of covered entity		2/5/2020 4:02 PM
Addresses	Shipping Address	Insert	Change Request		Umpqua Community Health Center 150 Kenneth Ford Drive Roseburg, OR 97470	8/27/2019 9:27 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Bolton, KC CEO Umpqua Community Health Center 5416729596-103	5/30/2019 1:39 PM
Details	340B ID	Update	New Registration	CH10310D	CH10310J	5/30/2019 1:39 PM
Dates	Participating Approval Date	Update	New Registration		5/30/2019 1:39:13 PM	5/30/2019 1:39 PM
Details	State	Update	New Registration	Pending	Approved	5/30/2019 1:39 PM
Dates	Signed By Date	Update	New Registration	7/10/2007 12:00:00 AM	5/30/2019 12:56:48 PM	5/30/2019 1:39 PM
Dates	Start Date	Update	New Registration	10/1/2007 12:00:00 AM	7/1/2019 12:00:00 AM	5/30/2019 1:39 PM
Addresses	Main Address	Insert	New Registration		316 W. A STREET DRAIN, OR 97435-0158	5/29/2019 5:29 PM
Addresses	Billing Address	Insert	New Registration		UMPQUA COMMUNITY HEALTH CENTER 150 KENNETH FORD DR ROSEBURG, OR 97470	5/29/2019 5:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/29/2019 5:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		168395	5/29/2019 5:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	5/29/2019 5:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1649469909	5/29/2019 5:29 PM
Contacts	Authorizing Official	Insert	New Registration		Bolton, KC CEO Umpqua Community Health Center 5416729596-103	5/29/2019 5:29 PM
Contacts	Primary Contact	Insert	New Registration		Davis, Shannon 340B Program Manager Umpqua Community Health Center 5416729596-403	5/29/2019 5:29 PM
Details	Last Recertification Date	Insert	New Registration			5/29/2019 5:29 PM
Details	Grant Number	Insert	New Registration		H80CS00567	5/29/2019 5:29 PM
Details	340B ID	Insert	New Registration		CH10310D	5/29/2019 5:29 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			5/29/2019 5:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			5/29/2019 5:29 PM
Details	Medicare Provider Number	Insert	New Registration			5/29/2019 5:29 PM
Details	Entity Name	Insert	New Registration		Umpqua Community Health Center, Inc	5/29/2019 5:29 PM
Details	Program Code	Insert	New Registration		CH	5/29/2019 5:29 PM
Details	Entity Subname	Insert	New Registration		UMPQUA COMM HLTH CTR @ DRAIN	5/29/2019 5:29 PM
Dates	Participating Approval Date	Insert	New Registration			5/29/2019 5:29 PM
Details	State	Insert	New Registration		Pending	5/29/2019 5:29 PM
Dates	Registration Date	Insert	New Registration		5/29/2019 5:29:50 PM	5/29/2019 5:29 PM
Dates	Signed By Date	Insert	New Registration		7/10/2007 12:00:00 AM	5/29/2019 5:29 PM
Dates	Start Date	Insert	New Registration		10/1/2007 12:00:00 AM	5/29/2019 5:29 PM
Terminations	Termination Comments	Insert	New Registration			5/29/2019 5:29 PM
Terminations	Termination Date	Insert	New Registration			5/29/2019 5:29 PM
Terminations	Termination Effective Date	Insert	New Registration			5/29/2019 5:29 PM
Terminations	Termination Reason	Insert	New Registration		At request of covered entity	5/29/2019 5:29 PM

340B Drug Pricing Program Database