340B Drug Pricing Program Database
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DSH380061B PROVIDENCE PORTLAND MEDICAL CENTER (Active)
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Main Details
Name
PROVIDENCE PORTLAND MEDICAL CENTER
Subdivision Name
Anticoagulation Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380061B
Medicare Provider Number
380061
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/16/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/15/2017
Last Recertification Date
9/4/2024
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
5050 NE Hoyt St
Suite B-45
Portland, OR 97213
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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