Covered Entity Details

CH10629C Outside In (Active) - information as of 6/21/2025 12:06:20 AM

Main Details

Name

Outside In

Subdivision Name

Outside In East Side

Type

HRSA-Funded Health Center

Site ID

BPS-H80-031044

340B ID

CH10629C

Grant Number

H80CS00243

Additional Details

Current Program Status

Active

Registration Date

8/24/2020

Participating Start Date

10/1/2020

Participating Approval Date

8/27/2020

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Outside In
Iris Martin, Interim Co-Executive Director
(503) 734-6758

Primary Contact

Outside In
Mindy Butler, Pharmacy Director
(503) 535-3888

Addresses

Street Address

16144 E Burnside St
Portland, OR 97233-3520

Billing Address

Outside In
1132 SW 13th Avenue
Portland, OR 97205

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	500733673,181559,500782334,500605433,500812509,500812306	1972124196,1477005619,1104193283,1215178462,1306594445,1275280729,1568401347

Shipping Addresses

Shipping Address 1

Outside In
1132 SW 13th Avenue
Portland, OR 97205

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
CH106290	Active	BPS-H80-005130	OUTSIDE IN	OUTSIDE IN	1132 SW 13th Ave	Portland	OR
CH10629A	Active	BPS-H80-018875	Outside In	Outside In 1226	1226 SW 12th Avenue	Portland	OR
CH10629B	Active	BPS-H80-010697	Outside In	Milwaukie High School Health and Wellness Center	2301 SE Willard St	Milwaukie	OR
CH10629C	Active	BPS-H80-031044	Outside In	Outside In East Side	16144 E Burnside St	Portland	OR
CH10629D	Active	BPS-H80-034330	Outside In	Laurelwood Center	6130 SE Foster Rd	Portland	OR
CH10629E	Terminated	BPS-H80-006398	OUTSIDE IN	Outreach Medical Van 1	9852 SE Empire Ct	Clackamas	OR
CH10629F	Terminated	BPS-H80-010699	OUTSIDE IN	Outreach Medical Van 2	9852 SE Empire Ct	Clackamas	OR
CH10629G	Active	BPS-H80-039017	OUTSIDE IN	Clackamas Service Center	8800 SE 80th Ave	Portland	OR

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH106290	FRED MEYER	1111 NE 102ND AVENUE		PORTLAND	OR	97220	07/01/2017	03/17/2019
CH106290	FRED MEYER #040	7555 SW BARBUR BLVD		PORTLAND	OR	97219	07/01/2017	03/17/2019
CH106290	FRED MEYER INC	8955 S.E. 82ND AVENUE		HAPPY VALLEY	OR	97086	07/01/2017	03/17/2019
CH106290	FRED MEYER STORES INC	FRED MEYER PHARMACY #360	100 NW 20TH PLACE	PORTLAND	OR	97209	10/01/2017	03/17/2019
CH106290	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	07/01/2017	03/17/2019
CH106290	KROGER PHARMACY L-360	6900 BARDSTOWN ROAD		LOUISVILLE	KY	40291	07/01/2017	04/17/2017
CH106290	LUNDGREN	DBA CENTRAL DRUG	538 SW 4TH	PORTLAND	OR	97204	10/01/2017	10/25/2017
CH106290	SAFEWAY INC	SAFEWAY PHARMACY #2448	1010 SW JEFFERSON ST	PORTLAND	OR	97201-3425	07/01/2017	04/09/2022

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/8/2024 5:05:08 PM	2/12/2025 12:27:22 AM	2/12/2025 12:27 AM
Contacts	Authorizing Official	Update	Group Change Request	Carter, Kathleen Health Services Director Outside In 4843543311	Martin, Iris Interim Co-Executive Director Outside In 5037346758	2/9/2025 12:33 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568401347	3/14/2024 6:39 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	3/14/2024 6:39 PM
Details	Last Recertification Date	Update	Recertification	2/10/2023 1:20:13 PM	2/8/2024 5:05:08 PM	2/8/2024 5:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/10/2023 1:20 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500812509	2/10/2023 1:20 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/10/2023 1:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/10/2023 1:20 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500812306	2/10/2023 1:20 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	2/10/2023 1:20 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1306594445	2/10/2023 1:20 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/10/2023 1:20 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275280729	2/10/2023 1:20 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	2/10/2023 1:20 PM
Details	Last Recertification Date	Update	Recertification	2/3/2022 11:20:36 AM	2/10/2023 1:20:13 PM	2/10/2023 1:20 PM
Contacts	Authorizing Official	Update	Change Request	Patron, Patricia Executive Director Outside In 5035353801	Carter, Kathleen Health Services Director Outside In 4843543311	6/22/2022 6:29 AM
Details	Last Recertification Date	Update	Recertification	2/8/2021 12:55:35 PM	2/3/2022 11:20:36 AM	2/3/2022 11:20 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	In (OR)		11/19/2021 1:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	process (OR)		11/19/2021 1:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/19/2021 1:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500605433	11/19/2021 1:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	11/19/2021 1:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1215178462	11/19/2021 1:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		OR	11/19/2021 1:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	11/16/2021 10:09 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		500733673	11/16/2021 10:09 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OR	11/16/2021 10:09 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	11/16/2021 10:09 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		181559	11/16/2021 10:09 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OR	11/16/2021 10:09 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	11/16/2021 10:09 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		500782334	11/16/2021 10:09 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		OR	11/16/2021 10:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1477005619	11/16/2021 10:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	11/16/2021 10:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1104193283	11/16/2021 10:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		OR	11/16/2021 10:09 AM
Contacts	Authorizing Official	Update	Group Change Request	Ross, Bonnie Finance Director Outside In 5035353803	Patron, Patricia Executive Director Outside In 5035353801	11/16/2021 10:09 AM
Contacts	Primary Contact	Update	Group Change Request	Patron, Patricia Executive Director Outside In 5035353801	Butler, Mindy Pharmacy Director Outside In 5035353888	11/16/2021 10:09 AM
Details	Last Recertification Date	Update	Recertification		2/8/2021 12:55:35 PM	2/8/2021 12:55 PM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		Ross, Bonnie Finance Director Outside In 5035353803	8/27/2020 1:43 PM
Details	340B ID	Update	New Registration		CH10629C	8/27/2020 1:43 PM
Dates	Participating Approval Date	Update	New Registration		8/27/2020 1:43:29 PM	8/27/2020 1:43 PM
Details	State	Update	New Registration	Pending	Approved	8/27/2020 1:43 PM
Dates	Signed By Date	Update	New Registration		8/24/2020 5:48:01 PM	8/27/2020 1:43 PM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	8/27/2020 1:43 PM
Addresses	Main Address	Insert	New Registration		16144 E Burnside St Portland, OR 97233-3520	8/24/2020 5:47 PM
Addresses	Billing Address	Insert	New Registration		Outside In 1132 SW 13th Avenue Portland, OR 97205	8/24/2020 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Outside In 1132 SW 13th Avenue Portland, OR 97205	8/24/2020 5:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/24/2020 5:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		In	8/24/2020 5:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	8/24/2020 5:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	8/24/2020 5:47 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		process	8/24/2020 5:47 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	8/24/2020 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972124196	8/24/2020 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	8/24/2020 5:47 PM
Contacts	Authorizing Official	Insert	New Registration		Ross, Bonnie Finance Director Outside In 5035353803	8/24/2020 5:47 PM
Contacts	Primary Contact	Insert	New Registration		Patron, Patricia Executive Director Outside In 5035353801	8/24/2020 5:47 PM
Details	Assistance Received From Date	Insert	New Registration			8/24/2020 5:47 PM
Details	Assistance Received To Date	Insert	New Registration			8/24/2020 5:47 PM
Details	Last Recertification Date	Insert	New Registration			8/24/2020 5:47 PM
Details	Grant Number	Insert	New Registration		H80CS00243	8/24/2020 5:47 PM
Details	340B ID	Insert	New Registration			8/24/2020 5:47 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			8/24/2020 5:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			8/24/2020 5:47 PM
Details	Medicare Provider Number	Insert	New Registration			8/24/2020 5:47 PM
Details	Entity Name	Insert	New Registration		Outside In	8/24/2020 5:47 PM
Details	NOFO Number	Insert	New Registration			8/24/2020 5:47 PM
Details	Program Code	Insert	New Registration		CH	8/24/2020 5:47 PM
Details	Entity Subname	Insert	New Registration		Outside In East Side	8/24/2020 5:47 PM
Dates	Participating Approval Date	Insert	New Registration			8/24/2020 5:47 PM
Details	State	Insert	New Registration		Pending	8/24/2020 5:47 PM
Dates	Registration Date	Insert	New Registration		8/24/2020 5:47:58 PM	8/24/2020 5:47 PM
Dates	Signed By Date	Insert	New Registration			8/24/2020 5:47 PM
Dates	Start Date	Insert	New Registration			8/24/2020 5:47 PM
Terminations	Termination Comments	Insert	New Registration			8/24/2020 5:47 PM
Terminations	Termination Date	Insert	New Registration			8/24/2020 5:47 PM
Terminations	Termination Effective Date	Insert	New Registration			8/24/2020 5:47 PM
Terminations	Termination Reason	Insert	New Registration			8/24/2020 5:47 PM

340B Drug Pricing Program Database