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CH10766C CENTRAL CITY CONCERN (Active)
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Main Details
Name
CENTRAL CITY CONCERN
Subdivision Name
Old Town Clinic
Type
HRSA-Funded Health Center
Site ID
BPS-H80-000266
340B ID
CH10766C
Grant Number
H80CS00234
Additional Details
Current Program Status
Active
Registration Date
4/1/2004
Participating Start Date
4/1/2004
Participating Approval Date
8/24/2004
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
727 W BURNSIDE AVE
PORTLAND, OR 97209-3514
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
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9/2/10 ADDED NPI #; 8/31/10 ADDED SHIPPING ADDRESS (USES NAME ON DEA LICENSE); 9/6/07- ADDRESS CHANGE, PREVIOUS NAME- PORTLAND ALTERNATIVE HEALTH, PREVIOUS ADDRESS-625 SW 12TH; NEW SITE 04/01/2004
09/02/2010
April 2025
April 2025
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