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DSH380021B TUALITY HEALTHCARE (Terminated)
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Main Details
Name
TUALITY HEALTHCARE
Subdivision Name
Westside Medical Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380021B
Medicare Provider Number
380021
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/1/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/26/2012
Last Recertification Date
8/15/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Tuality Healthcare
Lori K James-Nielsen, President
(503) 681-1177
Primary Contact
Tuality Healthcare
Kevin Declercque, Director of Pharmacy
(503) 681-1041
Addresses
Street Address
21255 NW Jacobson Rd #500
Hillsboro, OR 97124
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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