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CH10112Z COUNTY OF MULTNOMAH (Terminated)
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Main Details
Name
COUNTY OF MULTNOMAH
Subdivision Name
LANE MIDDLE SCHOOL STUDENT HEALTH CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001176
340B ID
CH10112Z
Grant Number
H80CS00149
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/4/2013
Last Recertification Date
2/12/2018
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Multnomah County
Mark Lewis, Administrator
(503) 988-7462
Primary Contact
Multnomah County
CAMMY GADDIS, Finance Specialist
(503) 988-7468
Addresses
Street Address
7200 SE 60th Ave
Portland, OR 97206-7532
Billing Address
LANE MIDDLE SCHOOL-BASED HEALTH
421 SW Oak St.
Ste. 210
Portland, OR 97204
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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