340B Drug Pricing Program Database
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DSH380061A PROVIDENCE PORTLAND MEDICAL CENTER (Active)
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Main Details
Name
PROVIDENCE PORTLAND MEDICAL CENTER
Subdivision Name
PROV CANCER CENTER INFUSION - WEST
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380061A
Medicare Provider Number
380061
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/8/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Providence
Kate Buzbee, CFO
(971) 300-4268
Primary Contact
Providence Health and Services
Mac Ovenell, 340B Director
(509) 860-8643
Addresses
Street Address
9135 SW BARNES RD STE 263
PORTLAND, OR 97225-6646
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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