Yes
| Contract Detail | GENOA HEALTHCARE LLC | 998 LIBRARY CT. ROOM 4 |
| OREGON CITY | OR | 97045 | 04/14/2022 | 07/01/2022 | | 01/12/2023 | 01/13/2023 |
| Contract Detail | GENOA HEALTHCARE LLC | 3036 NE MARTIN LUTHER KING JR BLVD |
STE 136
| PORTLAND | OR | 97212 | 04/14/2022 | 07/01/2022 | | | 07/01/2022 |
| Contract Detail | GENOA HEALTHCARE LLC | 18417 SE OAK STREET |
| PORTLAND | OR | 97233 | 01/13/2023 | 04/01/2023 | | | 04/01/2023 |
| Contract Detail | GENOA HEALTHCARE LLC | 10700 SW BEAVERTON HILLSDALE HWY |
BLDG 1, RM 122
| BEAVERTON | OR | 97005 | 10/01/2024 | 01/01/2025 | | | 01/01/2025 |
| Contract Detail | GENOA HEALTHCARE LLC | 18613 SE STARK ST STE P |
| PORTLAND | OR | 97233 | 10/01/2024 | 01/01/2025 | | | 01/01/2025 |
| Contract Detail | GENOA HEALTHCARE LLC | 2502 E FOURTH PLAIN BLVD RM 102 |
| VANCOUVER | WA | 98661 | 10/01/2024 | 01/01/2025 | | | 01/01/2025 |
| Contract Detail | GENOA HEALTHCARE LLC | 150 BEAVERCREEK RD STE 304 |
| OREGON CITY | OR | 97045 | 10/01/2024 | 01/01/2025 | | | 01/01/2025 |
| Contacts | Authorizing Official | Update | Group Change Request | Osibanjo, Oyinda
Senior Director of Integrated Health Services
Cascadia Health
5039637792 | Trachtenberg, Robert
Senior Director Health Center Operations
Cascadia Health
5039637661 | 4/7/2025 12:08 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2024 1:50:30 PM | 2/14/2025 2:58:18 PM | 2/14/2025 2:58 PM |
| Contacts | Primary Contact | Update | AO Change Request | Sevos, Eric
Chief Strategy Officer
Cascadia Health
5038041600 | Coker, Deryk
340B Compliance Specialist
Cascadia Health
5032380769 | 9/20/2024 1:45 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Walker, Derald
President/CEO
Cascadia Behavioral Healthcare
5032380769 | Osibanjo, Oyinda
Senior Director of Integrated Health Services
Cascadia Health
5039637792 | 9/20/2024 1:45 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 9/10/2024 6:41 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 500780599 | 9/10/2024 6:41 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | OR | 9/10/2024 6:41 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1538208129 | 9/10/2024 6:41 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | OR | 9/10/2024 6:41 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 3:40:02 PM | 1/30/2024 1:50:30 PM | 1/30/2024 1:50 PM |
| Details | Entity Name | Update | Change Request | CASCADIA BEHAVIORAL HEALTHCARE, INC. | Cascadia Health | 9/8/2023 8:03 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Sevos, Eric
Chief Strategy Officer
Cascadia Behavioral Healthcare
5038041600 | Sevos, Eric
Chief Strategy Officer
Cascadia Health
5038041600 | 8/24/2023 7:50 AM |
| Details | Last Recertification Date | Update | Recertification | | 1/30/2023 3:40:02 PM | 1/30/2023 3:40 PM |
| Details | State | Update | OPA Edit | Approved | Active | 3/7/2022 3:47 PM |
| Dates | Start Date | Update | OPA Edit | 4/1/2022 12:00:00 AM | 3/7/2022 12:00:00 AM | 3/7/2022 3:47 PM |
| Contacts | Signed By | Insert | New Registration | | Walker, Derald
President/CEO
Cascadia Behavioral Healthcare
5032380769 | 3/7/2022 3:31 PM |
| Details | 340B ID | Update | New Registration | | FQHCLA433C | 3/7/2022 3:31 PM |
| Dates | Participating Approval Date | Update | New Registration | | 3/7/2022 3:31:50 PM | 3/7/2022 3:31 PM |
| Details | State | Update | New Registration | Pending | Approved | 3/7/2022 3:31 PM |
| Dates | Signed By Date | Update | New Registration | | 3/7/2022 1:55:28 PM | 3/7/2022 3:31 PM |
| Dates | Start Date | Update | New Registration | | 4/1/2022 12:00:00 AM | 3/7/2022 3:31 PM |
| Addresses | Main Address | Insert | New Registration | |
3036 NE M L King Blvd
Portland, OR 97212-3053 | 3/7/2022 1:55 PM |
| Contacts | Primary Contact | Insert | New Registration | | Sevos, Eric
Chief Strategy Officer
Cascadia Behavioral Healthcare
5038041600 | 3/7/2022 1:55 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Walker, Derald
President/CEO
Cascadia Behavioral Healthcare
5032380769 | 3/7/2022 1:55 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Details | Grant Number | Insert | New Registration | | LALCS40208 | 3/7/2022 1:55 PM |
| Details | 340B ID | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Details | Entity Name | Insert | New Registration | | CASCADIA BEHAVIORAL HEALTHCARE, INC. | 3/7/2022 1:55 PM |
| Details | NOFO Number | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Details | Program Code | Insert | New Registration | | FQHCLA | 3/7/2022 1:55 PM |
| Details | Entity Subname | Insert | New Registration | | Cascadia Garlington Health Center | 3/7/2022 1:55 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Details | State | Insert | New Registration | | Pending | 3/7/2022 1:55 PM |
| Dates | Registration Date | Insert | New Registration | | 3/7/2022 1:55:25 PM | 3/7/2022 1:55 PM |
| Dates | Signed By Date | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Dates | Start Date | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Terminations | Termination Date | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 3/7/2022 1:55 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 3/7/2022 1:55 PM |