Covered Entity Details

CHC24160-12 Neighborhood Health Center (Active) - information as of 5/1/2025 10:10:26 PM

Main Details

Name

Neighborhood Health Center

Subdivision Name

NHC Oregon City Medical Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-030104

340B ID

CHC24160-12

Grant Number

H80CS24160

Additional Details

Current Program Status

Active

Registration Date

1/14/2020

Participating Start Date

4/1/2020

Participating Approval Date

3/1/2020

Last Recertification Date

2/19/2025

Contacts

Authorizing Official

Neighborhood Health Center
Blain A. West, CFO / COO
(503) 941-3028

Primary Contact

Neighborhood Health Center
Phillip Kotlyarevskiy, 340B Pharmacy Manager
(503) 214-1065

Addresses

Street Address

728 Molalla Ave
Oregon City, OR 97045-2799

Billing Address

Neighborhood Health Center
7320 SW Hunziker Rd STE 300
Portland, OR 97223

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	500670049,500775446	1174820815,1457902561,1487297255

Shipping Addresses

Same as Street Address

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
Contract Detail	FRED MEYER STORES INC	FRED MEYER PHARMACY #242	1839 MOLALLA AVENUE	OREGON CITY	OR	97045	10/14/2024	01/01/2025			01/01/2025
Contract Detail	FRED MEYER STORES INC	FRED MEYER PHARMACY #651	1401 SE FIRST AVE	CANBY	OR	97013	10/14/2024	01/01/2025			01/01/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC24160-00	Active	BPS-H80-030014	Neighborhood Health Center	NHC Administration and Pharmacy	7320 SW Hunziker Rd STE 300	Portland	OR
CHC24160-01	Active	BPS-H80-038795	Neighborhood Health Center	NHC Canby Medical and Dental Clinic	227 NW 3rd Ave	Canby	OR
CHC24160-02	Active	BPS-H80-012592	Neighborhood Health Center	NHC Oregon City Dental Clinic	19029 Beavercreek Rd	Oregon City	OR
CHC24160-03	Active	BPS-H80-014539	Neighborhood Health Center	NHC Milwaukie Medical Clinic	10330 SE 32nd Ave Ste 325	Milwaukie	OR
CHC24160-04	Terminated	BPS-H80-013668	Neighborhood Health Center	Neighborhood Health Center Beaverton B-2	17175 SW Tv Hwy Suite B-2	Beaverton	OR
CHC24160-05	Terminated	BPS-H80-013669	Neighborhood Health Center	Neighborhood Health Center Beaverton Suite A	17175 SW TV HWY Suite A	Beaverton	OR
CHC24160-06	Active	BPS-H80-013943	Neighborhood Health Center	NHC Milwaukie Dental Clinic	3300 SE DWYER DR	MILWAUKIE	OR
CHC24160-07	Active	BPS-H80-031208	NEIGHBORHOOD HEALTH CENTER	NHC Merlo Station SBHC	1841 SW Merlo Drive RM SBHC	Beaverton	OR
CHC24160-08	Active	BPS-H80-027336	NEIGHBORHOOD HEALTH CENTER	NHC Tanasbourne Medical & Dental Clinic	10690 NE Cornell Rd Ste 220	Hillsboro	OR
CHC24160-09	Active	BPS-H80-016954	Neighborhood Health Center	NHC Hillsboro Reproductive Health Clinic	266 W Main Street	Hillsboro	OR
CHC24160-10	Active	BPS-H80-031239	Neighborhood Health Center	NHC Tualatin SBHC	22300 SW Boones Ferry Road RM 26A	Tualatin	OR
CHC24160-11	Terminated	BPS-H80-030103	Neighborhood Health Center	NHC Beaverton Medical Clinic	17200 NW Corridor Ct Ste 110	Beaverton	OR
CHC24160-12	Active	BPS-H80-030104	Neighborhood Health Center	NHC Oregon City Medical Clinic	728 Molalla Ave	Oregon City	OR

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC24160-00	ALBERTSONS LLC	SAV-ON PHARMACY #571	19007 S. BEAVERCREEK RD	OREGON CITY	OR	97045	10/01/2017
CHC24160-00	ALBERTSONS LLC	SAFEWAY PHARMACY #3542	14300 SW BARROWS RD	TIGARD	OR	97223	10/01/2017
CHC24160-00	ALBERTSONS LLC	SAFEWAY PHARMACY #591	888 NE 25TH AVENUE	HILLSBORO	OR	97124	10/01/2017
CHC24160-00	ALBERTSONS LLC	SAV-ON PHARMACY #590	7500 W. BASELINE	HILLSBORO	OR	97123	10/01/2017
CHC24160-00	ALBERTSONS LLC	SAV-ON PHARMACY #505	5415 SW BEAVERTON HILLSDALE HWY	PORTLAND	OR	97221	10/01/2017	04/10/2018
CHC24160-08	ALBERTSONS LLC	SAFEWAY PHARMACY #3542	14300 SW BARROWS RD	TIGARD	OR	97223	01/01/2025
CHC24160-08	ALBERTSONS LLC	SAV-ON PHARMACY #590	7500 W. BASELINE	HILLSBORO	OR	97123	01/01/2025
CHC24160-08	ALBERTSONS LLC	SAV-ON PHARMACY #571	19007 S. BEAVERCREEK RD	OREGON CITY	OR	97045	01/01/2025
CHC24160-08	ALBERTSONS LLC	SAFEWAY PHARMACY #591	888 NE 25TH AVENUE	HILLSBORO	OR	97124	01/01/2025
CHC24160-00	CREDENA HEALTH PHARMACY PPMC PLAZA	5050 NE HOYT ST STE 142		PORTLAND	OR	97213	07/01/2019
CHC24160-08	CREDENA HEALTH PHARMACY PPMC PLAZA	5050 NE HOYT ST STE 142		PORTLAND	OR	97213	01/01/2025
CHC24160-00	CREDENA HEALTH PHARMACY ST VINCENT	9155 SW BARNES RD STE 102		PORTLAND	OR	97225-6625	07/01/2019
CHC24160-08	CREDENA HEALTH PHARMACY ST VINCENT	9155 SW BARNES RD STE 102		PORTLAND	OR	97225-6625	01/01/2025
CHC24160-00	CREDENA HEALTH PHARMACY TANASBOURNE	10670 NE CORNELL RD STE 102		HILLSBORO	OR	97124-9221	10/01/2019
CHC24160-08	CREDENA HEALTH PHARMACY TANASBOURNE	10670 NE CORNELL RD STE 102		HILLSBORO	OR	97124-9221	01/01/2025
CHC24160-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2024
CHC24160-08	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2025
CHC24160-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2024
CHC24160-08	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2025
CHC24160-00	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2024
CHC24160-08	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2025
CHC24160-00	FRED MEYER	11425 S.W. BEAVERTON HILLSDALE		BEAVERTON	OR	97005	07/01/2017
CHC24160-00	FRED MEYER	CLACKAMAS STORE	16301 S E 82ND DRIVE	CLACKAMAS	OR	97015	07/01/2017
CHC24160-00	FRED MEYER	6615 NE GLISAN ST		PORTLAND	OR	97213	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER	2497 SE BURNSIDE RD		GRESHAM	OR	97080	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER	1111 NE 102ND AVENUE		PORTLAND	OR	97220	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER	3805 SE HAWTHORNE BLVD		PORTLAND	OR	97214	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER	7700 S.W. BEAVERTON-HILLSDALE		PORTLAND	OR	97225	07/01/2017	09/09/2019
CHC24160-00	FRED MEYER	11565 SW PACIFIC HIWAY		TIGARD	OR	97223	07/01/2017
CHC24160-00	FRED MEYER	2500 NORTH MAIN STREET		TILLAMOOK	OR	97141	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER	19200 S.W. MARTINAZZI AVENUE		TUALATIN	OR	97062	07/01/2017
CHC24160-00	FRED MEYER	PHARMACY # 00516	30300 SW BOONES FERRY ROAD	WILSONVILLE	OR	97070-6759	07/01/2017
CHC24160-08	FRED MEYER	19200 S.W. MARTINAZZI AVENUE		TUALATIN	OR	97062	01/01/2025
CHC24160-08	FRED MEYER	PHARMACY # 00516	30300 SW BOONES FERRY ROAD	WILSONVILLE	OR	97070-6759	01/01/2025
CHC24160-08	FRED MEYER	11565 SW PACIFIC HIWAY		TIGARD	OR	97223	01/01/2025
CHC24160-08	FRED MEYER	CLACKAMAS STORE	16301 S E 82ND DRIVE	CLACKAMAS	OR	97015	01/01/2025
CHC24160-08	FRED MEYER	11425 S.W. BEAVERTON HILLSDALE		BEAVERTON	OR	97005	01/01/2025
CHC24160-00	FRED MEYER #040	7555 SW BARBUR BLVD		PORTLAND	OR	97219	07/01/2017	03/30/2018
CHC24160-00	FRED MEYER #660	PHARMACY DEPARTMENT	22855 NE PARKLANE	WOOD VILLAGE	OR	97060	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER #661	7355 NE IMBRIE DR STE A		HILLSBORO	OR	97124-7596	07/01/2017
CHC24160-08	FRED MEYER #661	7355 NE IMBRIE DR STE A		HILLSBORO	OR	97124-7596	01/01/2025
CHC24160-00	FRED MEYER 663	16625 362ND AVENUE		SANDY	OR	97055	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER INC	PHARMACY DEPARTMENT	2200 BASE LINE STREET	CORNELIUS	OR	97113	07/01/2017
CHC24160-00	FRED MEYER INC	PHARMACY DEPARTMENT	14700 SE DIVISION	PORTLAND	OR	97236	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER INC	8955 S.E. 82ND AVENUE		HAPPY VALLEY	OR	97086	07/01/2017
CHC24160-00	FRED MEYER INC	DBA FRED MEYER	695 HWY 101	WARRENTON	OR	97146	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER INC	3300 PORTLAND ROAD		NEWBERG	OR	97132	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER INC	6850 N LOMBARD		PORTLAND	OR	97203	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER INC	DBA FRED MEYER	15995 S.W. WALKER ROAD	BEAVERTON	OR	97006-4944	07/01/2017
CHC24160-00	FRED MEYER INC	ATTN: PHARMACY	3030 NE WEIDLER	PORTLAND	OR	97232	07/01/2017	10/31/2017
CHC24160-07	FRED MEYER INC	DBA FRED MEYER	15995 S.W. WALKER ROAD	BEAVERTON	OR	97006-4944	01/01/2025
CHC24160-08	FRED MEYER INC	DBA FRED MEYER	15995 S.W. WALKER ROAD	BEAVERTON	OR	97006-4944	01/01/2025
CHC24160-08	FRED MEYER INC	PHARMACY DEPARTMENT	2200 BASE LINE STREET	CORNELIUS	OR	97113	01/01/2025
CHC24160-08	FRED MEYER INC	8955 S.E. 82ND AVENUE		HAPPY VALLEY	OR	97086	01/01/2025
CHC24160-00	FRED MEYER PHARMACY	6495 SE TUALATIN VALLEY HWY		HILLSBORO	OR	97123	07/01/2017
CHC24160-09	FRED MEYER PHARMACY	6495 SE TUALATIN VALLEY HWY		HILLSBORO	OR	97123	01/01/2025
CHC24160-08	FRED MEYER PHARMACY	6495 SE TUALATIN VALLEY HWY		HILLSBORO	OR	97123	01/01/2025
CHC24160-00	FRED MEYER STORES INC	FRED MEYER PHARMACY #240	14700 SE MCLOUGHLIN BLVD	MILWAUKIE	OR	97267-1417	07/01/2017
CHC24160-00	FRED MEYER STORES INC	FRED MEYER PHARMACY #242	1839 MOLALLA AVENUE	OREGON CITY	OR	97045	07/01/2017
CHC24160-00	FRED MEYER STORES INC	FRED MEYER PHARMACY #330	5253 SE 82ND AVE	PORTLAND	OR	97266	07/01/2017	01/13/2018
CHC24160-00	FRED MEYER STORES INC	FRED MEYER PHARMACY #360	100 NW 20TH PLACE	PORTLAND	OR	97209	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER STORES INC	FRED MEYER PHARMACY #462	51501 COLUMBIA RIVER HWY	SCAPPOOSE	OR	97056	07/01/2017	10/31/2017
CHC24160-00	FRED MEYER STORES INC	FRED MEYER PHARMACY #651	1401 SE FIRST AVE	CANBY	OR	97013	07/01/2017
CHC24160-02	FRED MEYER STORES INC	FRED MEYER PHARMACY #240	14700 SE MCLOUGHLIN BLVD	MILWAUKIE	OR	97267-1417	01/01/2025
CHC24160-12	FRED MEYER STORES INC	FRED MEYER PHARMACY #242	1839 MOLALLA AVENUE	OREGON CITY	OR	97045	01/01/2025
CHC24160-12	FRED MEYER STORES INC	FRED MEYER PHARMACY #651	1401 SE FIRST AVE	CANBY	OR	97013	01/01/2025
CHC24160-08	FRED MEYER STORES INC	FRED MEYER PHARMACY #240	14700 SE MCLOUGHLIN BLVD	MILWAUKIE	OR	97267-1417	01/01/2025
CHC24160-08	FRED MEYER STORES INC	FRED MEYER PHARMACY #242	1839 MOLALLA AVENUE	OREGON CITY	OR	97045	01/01/2025
CHC24160-08	FRED MEYER STORES INC	FRED MEYER PHARMACY #651	1401 SE FIRST AVE	CANBY	OR	97013	01/01/2025
CHC24160-00	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	07/01/2017
CHC24160-08	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	01/01/2025
CHC24160-00	PROVIDENCE HEALTH & SERVICES - OREGON	PROVIDENCE TANASBOURNE PHARMACY	10670 NE CORNELL RD STE 102	HILLSBORO	OR	97124-9221	07/01/2017	06/30/2019
CHC24160-00	PROVIDENCE HEALTH & SERVICES - OREGON	PROVIDENCE PLAZA PHARMACY	5050 NE HOYT STREET SUITE #142	PORTLAND	OR	97213	07/01/2017	06/30/2019
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #1478	15570 SW PACIFIC HWY	TIGARD	OR	97224	10/01/2017	04/09/2018
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #2696	14840 SW WEBSTER ROAD	MILWUAKIE	OR	97267	10/01/2017
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #2993	13434 COLTON PLACE	OREGON CITY	OR	97045	10/01/2017
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #1751	1525 W MAIN ST	MOLALLA	OR	97038	10/01/2017
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #1525	13485 NW CORNELL RD	PORTLAND	OR	97229	10/01/2017
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #1203	2525 SE TV HWY	HILLSBORO	OR	97123	10/01/2017
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #2631	14555 SW TEAL BLVD	BEAVERTON	OR	97007	10/01/2017	04/09/2018
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #2690	4320 SE KING ROAD	MILWAUKIE	OR	97222	10/01/2017
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #1073	6194 SW MURRAY BLVD	BEAVERTON	OR	97008	10/01/2017
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #0382	3527 SE 122ND AVE	PORTLAND	OR	97236	10/01/2017	01/09/2021
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #1713	22000 SALAMO RD	WEST LINN	OR	97068	01/01/2018	04/10/2018
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #0406	2836 PACIFIC AVENUE	FOREST GROVE	OR	97116	01/01/2018
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #0508	401 A AVENUE	LAKE OSWEGO	OR	97034	01/01/2018	04/10/2018
CHC24160-00	SAFEWAY INC	SAFEWAY PHARMACY #2448	1010 SW JEFFERSON ST	PORTLAND	OR	97201-3425	01/01/2018	04/10/2018
CHC24160-02	SAFEWAY INC	SAFEWAY PHARMACY #2993	13434 COLTON PLACE	OREGON CITY	OR	97045	01/01/2025
CHC24160-10	SAFEWAY INC	SAFEWAY PHARMACY #1751	1525 W MAIN ST	MOLALLA	OR	97038	01/01/2025
CHC24160-07	SAFEWAY INC	SAFEWAY PHARMACY #1203	2525 SE TV HWY	HILLSBORO	OR	97123	01/01/2025
CHC24160-03	SAFEWAY INC	SAFEWAY PHARMACY #2690	4320 SE KING ROAD	MILWAUKIE	OR	97222	01/01/2025
CHC24160-08	SAFEWAY INC	SAFEWAY PHARMACY #1751	1525 W MAIN ST	MOLALLA	OR	97038	01/01/2025
CHC24160-08	SAFEWAY INC	SAFEWAY PHARMACY #2690	4320 SE KING ROAD	MILWAUKIE	OR	97222	01/01/2025
CHC24160-08	SAFEWAY INC	SAFEWAY PHARMACY #1525	13485 NW CORNELL RD	PORTLAND	OR	97229	01/01/2025
CHC24160-08	SAFEWAY INC	SAFEWAY PHARMACY #2993	13434 COLTON PLACE	OREGON CITY	OR	97045	01/01/2025
CHC24160-08	SAFEWAY INC	SAFEWAY PHARMACY #1203	2525 SE TV HWY	HILLSBORO	OR	97123	01/01/2025
CHC24160-08	SAFEWAY INC	SAFEWAY PHARMACY #2696	14840 SW WEBSTER ROAD	MILWUAKIE	OR	97267	01/01/2025
CHC24160-08	SAFEWAY INC	SAFEWAY PHARMACY #1073	6194 SW MURRAY BLVD	BEAVERTON	OR	97008	01/01/2025
CHC24160-08	SAFEWAY INC	SAFEWAY PHARMACY #0406	2836 PACIFIC AVENUE	FOREST GROVE	OR	97116	01/01/2025
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #5322	12575 SW WALKER ROAD	BEAVERTON	OR	97005	04/01/2017	08/05/2024
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #5323	14625 S.W. ALLEN BOULEVARD	BEAVERTON	OR	97007	04/01/2017	08/05/2024
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #4064	17495 SW FARMINGTON ROAD	ALOHA	OR	97007	04/01/2017	08/05/2024
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #5332	1900 MCLOUGHLIN BLVD.	OREGON CITY	OR	97045	04/01/2017	08/05/2024
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #5339	2021 NW 185TH AVENUE	HILLSBORO	OR	97124	04/01/2017
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #5321	20225 SW TUALATIN VALLEY HWY	ALOHA	OR	97003	04/01/2017	06/28/2022
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #5325	891 S.E. 1ST AVENUE	CANBY	OR	97013	04/01/2017	12/04/2023
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #5352	10860 S.E. OAK STREET	MILWAUKIE	OR	97222	04/01/2017	08/05/2024
CHC24160-00	THRIFTY PAYLESS, INC.	RITE AID #5353	12240 SW SCHOLLS FERRY ROAD	TIGARD	OR	97223	10/01/2019	08/05/2024
CHC24160-08	THRIFTY PAYLESS, INC.	RITE AID #5339	2021 NW 185TH AVENUE	HILLSBORO	OR	97124	01/01/2025
CHC24160-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017	10/29/2018
CHC24160-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2021	07/01/2024
CHC24160-00	WAL-MART PHARMACY 10-2552	4200 SE 82ND AVENUE		PORTLAND	OR	97266	04/01/2017	04/14/2023
CHC24160-00	WAL-MART PHARMACY 10-3144	15600 SE MCLOUGHLIN BLVD		MILWAUKIE	OR	97267	04/01/2017	07/01/2024
CHC24160-00	WAL-MART PHARMACY 10-4221	220 N ADAIR		CORNELIUS	OR	97113	07/01/2019	07/01/2024
CHC24160-00	WAL-MART PHARMACY 10-5440	10000 SOUTHEAST 82ND AVENUE		HAPPY VALLEY	OR	97086	04/01/2017	07/01/2024
CHC24160-00	WAL-MART PHARMACY 10-5993	17275 NW CORNELL RD		BEAVERTON	OR	97006	04/01/2017	07/01/2024
CHC24160-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017	10/29/2018
CHC24160-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2021	07/01/2024
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 03801	1310 MOLALLA AVE	OREGON CITY	OR	97045	04/01/2017
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 06852	19975 SW TUALATIN VALLEY HWY	ALOHA	OR	97003	04/01/2017
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 09544	10903 SE OAK ST	MILWAUKIE	OR	97222-6641	04/01/2017
CHC24160-00	WALGREEN CO.	DBA: WALGREENS #10893	1080 SW 1ST AVE.	CANBY	OR	97013-3828	04/01/2017
CHC24160-00	WALGREEN CO.	DBA: WALGREENS #15403	18470 SW FARMINGTON ROAD	BEAVERTON	OR	97007	04/01/2017
CHC24160-00	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21151	1215 NW 23RD AVE	PORTLAND	OR	97210	07/01/2018
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 06831	7010 NE CORNELL ROAD	HILLSBORO	OR	97124-5422	01/01/2020
CHC24160-00	WALGREEN CO.	DBA: WALGREENS #15071	13470 NW CORNELL RD	PORTLAND	OR	97229-5651	01/01/2020
CHC24160-00	WALGREEN CO.	DBA: WALGREENS #11719	6215 SE TUALATIN VALLEY HWY.	HILLSBORO	OR	97123	01/01/2020	01/01/2020
CHC24160-00	WALGREEN CO.	DBA: WALGREENS #11719	6215 SE TUALATIN VALLEY HWY.	HILLSBORO	OR	97123	07/01/2024	11/13/2019
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 01100	9159 SE 82ND AVE	HAPPY VALLEY	OR	97086	07/01/2024
CHC24160-00	WALGREEN CO.	DBA: WALGREENS #13727	20100 MCLOUGHLIN BLVD.	GLADSTONE	OR	97027	07/01/2024
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 06370	14600 SW MURRAY SCHOLLS DR #201	BEAVERTON	OR	97007	07/01/2024
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 07688	9450 SW WILSONVILLE RD	WILSONVILLE	OR	97070	07/01/2024
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 05780	13939 SW PACIFIC HWY	TIGARD	OR	97223	07/01/2024
CHC24160-00	WALGREEN CO.	DBA: WALGREENS # 01082	4816 NW BETHANY BLVD	PORTLAND	OR	97229-9254	07/01/2024
CHC24160-00	WALGREEN CO.	DBA: WALGREENS #13780	955 SE BASELINE ST.	HILLSBORO	OR	97123-4207	07/01/2024
CHC24160-06	WALGREEN CO.	DBA: WALGREENS #15403	18470 SW FARMINGTON ROAD	BEAVERTON	OR	97007	01/01/2025
CHC24160-06	WALGREEN CO.	DBA: WALGREENS # 03801	1310 MOLALLA AVE	OREGON CITY	OR	97045	01/01/2025
CHC24160-03	WALGREEN CO.	DBA: WALGREENS # 09544	10903 SE OAK ST	MILWAUKIE	OR	97222-6641	01/01/2025
CHC24160-09	WALGREEN CO.	DBA: WALGREENS # 06831	7010 NE CORNELL ROAD	HILLSBORO	OR	97124-5422	01/01/2025
CHC24160-10	WALGREEN CO.	DBA: WALGREENS # 06852	19975 SW TUALATIN VALLEY HWY	ALOHA	OR	97003	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 07688	9450 SW WILSONVILLE RD	WILSONVILLE	OR	97070	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 01100	9159 SE 82ND AVE	HAPPY VALLEY	OR	97086	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 01082	4816 NW BETHANY BLVD	PORTLAND	OR	97229-9254	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS #11719	6215 SE TUALATIN VALLEY HWY.	HILLSBORO	OR	97123	01/01/2025	11/13/2019
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 06370	14600 SW MURRAY SCHOLLS DR #201	BEAVERTON	OR	97007	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS #10893	1080 SW 1ST AVE.	CANBY	OR	97013-3828	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS #13727	20100 MCLOUGHLIN BLVD.	GLADSTONE	OR	97027	01/01/2025
CHC24160-08	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21151	1215 NW 23RD AVE	PORTLAND	OR	97210	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS #15071	13470 NW CORNELL RD	PORTLAND	OR	97229-5651	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 03801	1310 MOLALLA AVE	OREGON CITY	OR	97045	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS #13780	955 SE BASELINE ST.	HILLSBORO	OR	97123-4207	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 06831	7010 NE CORNELL ROAD	HILLSBORO	OR	97124-5422	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 09544	10903 SE OAK ST	MILWAUKIE	OR	97222-6641	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 06852	19975 SW TUALATIN VALLEY HWY	ALOHA	OR	97003	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS #15403	18470 SW FARMINGTON ROAD	BEAVERTON	OR	97007	01/01/2025
CHC24160-08	WALGREEN CO.	DBA: WALGREENS # 05780	13939 SW PACIFIC HWY	TIGARD	OR	97223	01/01/2025
CHC24160-00	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/01/2024
CHC24160-08	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	01/01/2025
CHC24160-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2024
CHC24160-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2024
CHC24160-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2024
CHC24160-08	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2025
CHC24160-08	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2025
CHC24160-08	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2025
CHC24160-00	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/01/2024
CHC24160-08	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	01/01/2025
CHC24160-00	WALMART PHARMACY 10-2590	7650 NE SHALEEN STREET		HILLSBORO	OR	97006	07/01/2019	07/01/2024
CHC24160-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2024	07/01/2024
CHC24160-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/01/2024	07/01/2024
CHC24160-00	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	07/01/2017	06/30/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 8:08:23 PM	2/19/2025 4:33:02 PM	2/19/2025 4:33 PM
Contacts	Primary Contact	Update	Profile Change Request	Kotlyarevskiy, Phillip 340B Pharmacy Manager Neighborhood Health Center 5039149777	Kotlyarevskiy, Phillip 340B Pharmacy Manager Neighborhood Health Center 5032141065	2/19/2025 11:59 AM
Contacts	Primary Contact	Update	PC Change Request	McElravey, Jennifer Beckham Pharmacy Director Neighborhood Health Center 5039264300	Kotlyarevskiy, Phillip 340B Pharmacy Manager Neighborhood Health Center 5039149777	10/22/2024 10:55 AM
Details	Last Recertification Date	Update	Recertification	2/24/2023 6:32:28 AM	1/29/2024 8:08:23 PM	1/29/2024 8:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/10/2024 9:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500775446	1/10/2024 9:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	1/10/2024 9:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1487297255	1/10/2024 9:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	1/10/2024 9:35 PM
Contacts	Primary Contact	Update	Group Change Request	Rosko, Zachary Robert Senior Manager of 340B Services Neighborhood Health Center 4123354183	McElravey, Jennifer Beckham Pharmacy Director Neighborhood Health Center 5039264300	11/16/2023 11:49 AM
Contacts	Primary Contact	Update	Recertification	Hunkins, Erin Director of HIT Neighborhood Health Center 5039413077	Rosko, Zachary Robert Senior Manager of 340B Services Neighborhood Health Center 4123354183	2/24/2023 6:32 AM
Details	Last Recertification Date	Update	Recertification	2/1/2022 7:46:25 PM	2/24/2023 6:32:28 AM	2/24/2023 6:32 AM
Details	Last Recertification Date	Update	Recertification	2/25/2021 4:06:02 PM	2/1/2022 7:46:25 PM	2/1/2022 7:46 PM
Addresses	Billing Address	Update	Recertification	Neighborhood Health Center 7320 SW Hunziker Road Suite 300 Portland, OR 97223	Neighborhood Health Center 7320 SW Hunziker Rd STE 300 Portland, OR 97223	2/25/2021 4:06 PM
Medicaid Billing	NPI: State	Update	Recertification		OR	2/25/2021 4:06 PM
Medicaid Billing	NPI: State	Update	Recertification		OR	2/25/2021 4:06 PM
Details	Last Recertification Date	Update	Recertification		2/25/2021 4:06:02 PM	2/25/2021 4:06 PM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		West, Blain A. CFO / COO Neighborhood Health Center 5039413028	3/1/2020 8:16 PM
Details	340B ID	Update	New Registration		CHC24160-12	3/1/2020 8:16 PM
Dates	Participating Approval Date	Update	New Registration		3/1/2020 8:16:08 PM	3/1/2020 8:16 PM
Details	State	Update	New Registration	Pending	Approved	3/1/2020 8:16 PM
Dates	Signed By Date	Update	New Registration		1/14/2020 8:54:16 PM	3/1/2020 8:16 PM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	3/1/2020 8:16 PM
Addresses	Main Address	Insert	New Registration		728 Molalla Ave Oregon City, OR 97045-2799	1/14/2020 8:54 PM
Addresses	Billing Address	Insert	New Registration		Neighborhood Health Center 7320 SW Hunziker Road Suite 300 Portland, OR 97223	1/14/2020 8:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2020 8:54 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		500670049	1/14/2020 8:54 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	1/14/2020 8:54 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174820815	1/14/2020 8:54 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1457902561	1/14/2020 8:54 PM
Contacts	Primary Contact	Insert	New Registration		Hunkins, Erin Director of HIT Neighborhood Health Center 5039413077	1/14/2020 8:54 PM
Contacts	Authorizing Official	Insert	New Registration		West, Blain A. CFO / COO Neighborhood Health Center 5039413028	1/14/2020 8:54 PM
Details	Last Recertification Date	Insert	New Registration			1/14/2020 8:54 PM
Details	Grant Number	Insert	New Registration		H80CS24160	1/14/2020 8:54 PM
Details	340B ID	Insert	New Registration			1/14/2020 8:54 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2020 8:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2020 8:54 PM
Details	Medicare Provider Number	Insert	New Registration			1/14/2020 8:54 PM
Details	Entity Name	Insert	New Registration		Neighborhood Health Center	1/14/2020 8:54 PM
Details	Program Code	Insert	New Registration		CH	1/14/2020 8:54 PM
Details	Entity Subname	Insert	New Registration		NHC Oregon City Medical Clinic	1/14/2020 8:54 PM
Dates	Participating Approval Date	Insert	New Registration			1/14/2020 8:54 PM
Details	State	Insert	New Registration		Pending	1/14/2020 8:54 PM
Dates	Registration Date	Insert	New Registration		1/14/2020 8:54:14 PM	1/14/2020 8:54 PM
Dates	Signed By Date	Insert	New Registration			1/14/2020 8:54 PM
Dates	Start Date	Insert	New Registration			1/14/2020 8:54 PM
Terminations	Termination Comments	Insert	New Registration			1/14/2020 8:54 PM
Terminations	Termination Date	Insert	New Registration			1/14/2020 8:54 PM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2020 8:54 PM
Terminations	Termination Reason	Insert	New Registration			1/14/2020 8:54 PM

340B Drug Pricing Program Database