340B Drug Pricing Program Database
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DSH380038B PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER (Active)
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Main Details
Name
PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER
Subdivision Name
RHEUMATOLOGY - RHEUMATOLOGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380038B
Medicare Provider Number
380038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/1/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/3/2024
Last Recertification Date
Contacts
Authorizing Official
Providence Willamette Falls Medical Center
Brad Walker Henry, Chief Executive
(503) 657-6915
Primary Contact
Providence Health and Services
Mac Ovenell, 340B Director
(509) 860-8643
Addresses
Street Address
1510 Division Street
Suite 170
Oregon City, OR 97045
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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