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APOTHECARY AT SALMON CREEK
DSH380007 LEGACY EMANUEL HOSPITAL & HEALTH CENTER
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Covered Entity Details
Entity Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380007
Entity Address
2801 N GANTENBEIN AVE
PORTLAND, OR 97227
Medicare Provider Number
380007
Participating Start Date
7/1/2007
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
APOTHECARY AT SALMON CREEK
Pharmacy Address
2121 NE 139TH ST STE 310
VANCOUVER, WA 98686
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carol Bradley, SVP and Chief Nursing Officer
(503) 415-5199
Contract Pharmacy Representative
Legacy Health
Elena Valcarlos, Pharmacy Systems Manager
(503) 413-7764
Signed By Date
1/14/2019
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