Covered Entity Details

CH10766Y CENTRAL CITY CONCERN (Active) - information as of 6/23/2025 11:56:20 PM

Main Details

Name

CENTRAL CITY CONCERN

Subdivision Name

River Haven Clinic

Type

HRSA-Funded Health Center

Site ID

BPS-H80-033450

340B ID

CH10766Y

Grant Number

H80CS00234

Additional Details

Current Program Status

Active

Registration Date

10/2/2023

Participating Start Date

1/1/2024

Participating Approval Date

10/4/2023

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Central City Concern
Andrew Mendenhall, CEO
(503) 294-1681

Primary Contact

Central City Concern
Chris Lagor, Compliance Manager
(971) 361-7769

Addresses

Street Address

5019 NE 102nd Ave
Portland, OR 97220-1199

Billing Address

Central City Concern
232 NW 6th Ave
Portland, OR 97209

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	276313	1881658276,1437624046,1114230331,1982382594

Shipping Addresses

Shipping Address 1

Blackburn Center
12121 E. Burnside St
Portland, OR 97216

Shipping Address 2

Old Town Clinic
727 West Burnside Street
Portland, OR 97209

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	Address Cont.	City	State
CH107660	Active	BPS-H80-004866	CENTRAL CITY CONCERN	CENTRAL CITY CONCERN	232 NW 6th Ave		Portland	OR
CH10766AA	Active	BPS-H80-037274	CENTRAL CITY CONCERN	Evergreen Crossing	8225 NE Wasco St		Portland	OR
CH10766AB	Active	BPS-H80-038012	CENTRAL CITY CONCERN	Mobile Service Unit 01	327 SE Yamhill St # 1		Portland	OR
CH10766AC	Active	BPS-H80-038996	CENTRAL CITY CONCERN	Minnesota Hotel Administrative Offices	338 NW 5th Ave		Portland	OR
CH10766AD	Active	BPS-H80-038997	CENTRAL CITY CONCERN	Clackamas Street Based Outreach Administration	19220 McLoughlin Blvd		Gladstone	OR
CH10766AE	Active	BPS-H80-039139	CENTRAL CITY CONCERN	Mobile Service Unit 2	327 SE Yamhill St #2		Portland	OR
CH10766B	Active	BPS-H80-008871	CENTRAL CITY CONCERN	Hooper Detoxification and Stabilization Center	10 N. Weidler St		Portland	OR
CH10766C	Active	BPS-H80-000266	CENTRAL CITY CONCERN	Old Town Clinic	727 W BURNSIDE AVE		PORTLAND	OR
CH10766D	Terminated	BPS-H80-000752	CENTRAL CITY CONCERN	THE HENRY BUILDING	309 SW 4TH STREET		PORTLAND	OR
CH10766E	Terminated	BPS-H80-001839	CENTRAL CITY CONCERN	CEP CONSUMER CENTER	610 NW Davis St		Portland	OR
CH10766H	Active	BPS-H80-003610	CENTRAL CITY CONCERN	LETTY OWINGS CENTER	2545 NE FLANDERS ST		PORTLAND	OR
CH10766K	Terminated	BPS-H80-001124	CENTRAL CITY CONCERN	CCC Recovery Center	726 W Burnside St		Portland	OR
CH10766M	Active	BPS-H80-003878	CENTRAL CITY CONCERN	Golden West Clinic	709 NW Everett St		Portland	OR
CH10766N	Active	BPS-H80-010936	CENTRAL CITY CONCERN	Old Town Recovery Center	33 NW Broadway		Portland	OR
CH10766P	Active	BPS-H80-017528	CENTRAL CITY CONCERN	Puentes	12672 SE Stark St Ste 12672		Portland	OR
CH10766Q	Terminated	BPS-H80-015261	CENTRAL CITY CONCERN	Bud Clark Commons	665 NW Hoyt Street		Portland	OR
CH10766R	Terminated	BPS-H80-012021	CENTRAL CITY CONCERN	Eastside Concern	1949 SE 122nd Avenue		Portland	OR
CH10766S	Active	BPS-H80-031319	CENTRAL CITY CONCERN	Hansen Clinic at Banfield Value Inn	1525 NE 37th Ave	Rm 38	Portland	OR
CH10766T	Active	BPS-H80-017148	CENTRAL CITY CONCERN	Hooper Detoxification and Stabilization Center	1535 N. Williams Ave		Portland	OR
CH10766U	Active	BPS-H80-024909	CENTRAL CITY CONCERN	Blackburn Center	12121 E. Burnside St		Portland	OR
CH10766V	Terminated	BPS-H80-027853	CENTRAL CITY CONCERN	Blackburn Center Recuperative Care Program	12133 E Burnside St		Portland	OR
CH10766W	Active	BPS-H80-032987	CENTRAL CITY CONCERN	Cedar Commons	11450 SE Division St Rm 115		Portland	OR
CH10766X	Active	BPS-H80-001784	CENTRAL CITY CONCERN	The Biltmore Building	523 NW EVERETT ST		PORTLAND	OR
CH10766Y	Active	BPS-H80-033450	CENTRAL CITY CONCERN	River Haven Clinic	5019 NE 102nd Ave		Portland	OR
CH10766Z	Active	BPS-H80-035484	CENTRAL CITY CONCERN	Imani Center (Karibu)	2040 SE Powell Blvd		Portland	OR

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH10766B	LUNDGREN	DBA CENTRAL DRUG	538 SW 4TH	PORTLAND	OR	97204	08/19/2004	08/10/2017
CH10766H	LUNDGREN	DBA CENTRAL DRUG	538 SW 4TH	PORTLAND	OR	97204	08/19/2004	08/10/2017
CH107660	LUNDGREN	DBA CENTRAL DRUG	538 SW 4TH	PORTLAND	OR	97204	08/19/2004	08/10/2017
CH10766E	LUNDGREN	DBA CENTRAL DRUG	538 SW 4TH	PORTLAND	OR	97204	08/19/2004	08/10/2017
CH10766C	LUNDGREN	DBA CENTRAL DRUG	538 SW 4TH	PORTLAND	OR	97204	08/19/2004	08/10/2017

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 12:02:28 PM	2/10/2025 10:33:52 AM	2/10/2025 10:33 AM
Contacts	Primary Contact	Update	Profile Change Request	Lagor, Chris 340B Compliance Manager Central City Concern 9713617769	Lagor, Chris Compliance Manager Central City Concern 9713617769	10/7/2024 1:21 PM
Details	Last Recertification Date	Update	Recertification		2/1/2024 12:02:28 PM	2/1/2024 12:02 PM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Mendenhall, Andrew CEO Central City Concern 5032941681	10/4/2023 1:25 PM
Details	340B ID	Update	New Registration		CH10766Y	10/4/2023 1:25 PM
Dates	Participating Approval Date	Update	New Registration		10/4/2023 1:25:15 PM	10/4/2023 1:25 PM
Details	State	Update	New Registration	Pending	Approved	10/4/2023 1:25 PM
Dates	Signed By Date	Update	New Registration		10/2/2023 5:27:44 PM	10/4/2023 1:25 PM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	10/4/2023 1:25 PM
Addresses	Main Address	Insert	New Registration		5019 NE 102nd Ave Portland, OR 97220-1199	10/2/2023 4:05 PM
Addresses	Billing Address	Insert	New Registration		Central City Concern 232 NW 6th Ave Portland, OR 97209	10/2/2023 4:05 PM
Addresses	Shipping Address	Insert	New Registration		Blackburn Center 12121 E. Burnside St Portland, OR 97216	10/2/2023 4:05 PM
Addresses	Shipping Address	Insert	New Registration		Old Town Clinic 727 West Burnside Street Portland, OR 97209	10/2/2023 4:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/2/2023 4:05 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		276313	10/2/2023 4:05 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	10/2/2023 4:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1881658276	10/2/2023 4:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	10/2/2023 4:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1437624046	10/2/2023 4:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	10/2/2023 4:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114230331	10/2/2023 4:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	10/2/2023 4:05 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1982382594	10/2/2023 4:05 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	10/2/2023 4:05 PM
Contacts	Primary Contact	Insert	New Registration		Lagor, Chris 340B Compliance Manager Central City Concern 9713617769	10/2/2023 4:05 PM
Contacts	Authorizing Official	Insert	New Registration		Mendenhall, Andrew CEO Central City Concern 5032941681	10/2/2023 4:05 PM
Details	Assistance Received From Date	Insert	New Registration			10/2/2023 4:05 PM
Details	Assistance Received To Date	Insert	New Registration			10/2/2023 4:05 PM
Details	Last Recertification Date	Insert	New Registration			10/2/2023 4:05 PM
Details	Grant Number	Insert	New Registration		H80CS00234	10/2/2023 4:05 PM
Details	340B ID	Insert	New Registration			10/2/2023 4:05 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/2/2023 4:05 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/2/2023 4:05 PM
Details	Medicare Provider Number	Insert	New Registration			10/2/2023 4:05 PM
Details	Entity Name	Insert	New Registration		CENTRAL CITY CONCERN	10/2/2023 4:05 PM
Details	NOFO Number	Insert	New Registration			10/2/2023 4:05 PM
Details	Program Code	Insert	New Registration		CH	10/2/2023 4:05 PM
Details	Entity Subname	Insert	New Registration		River Haven Clinic	10/2/2023 4:05 PM
Dates	Participating Approval Date	Insert	New Registration			10/2/2023 4:05 PM
Details	State	Insert	New Registration		Pending	10/2/2023 4:05 PM
Dates	Registration Date	Insert	New Registration		10/2/2023 4:05:09 PM	10/2/2023 4:05 PM
Dates	Signed By Date	Insert	New Registration			10/2/2023 4:05 PM
Dates	Start Date	Insert	New Registration			10/2/2023 4:05 PM
Terminations	Termination Comments	Insert	New Registration			10/2/2023 4:05 PM
Terminations	Termination Date	Insert	New Registration			10/2/2023 4:05 PM
Terminations	Termination Effective Date	Insert	New Registration			10/2/2023 4:05 PM
Terminations	Termination Reason	Insert	New Registration			10/2/2023 4:05 PM

340B Drug Pricing Program Database