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FRED MEYER PHARMACY
CH101230 VIRGINIA GARCIA MEMORIAL HEALTH CENTER
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Covered Entity Details
Entity Name
VIRGINIA GARCIA MEMORIAL HEALTH CENTER
Subdivision Name
VIRGINIA GARCIA MEMORIAL HEALTH CENTER - Cornelius
Type
HRSA-Funded Health Center
340B ID
CH101230
Entity Address
1151 N Adair Street
Cornelius, OR 97113-9029
Grant Number
H80CS00817
Participating Start Date
4/1/1996
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
FRED MEYER PHARMACY
Pharmacy Address
6495 SE TUALATIN VALLEY HWY
HILLSBORO, OR 97123
Pharmacy Comments
Contract Details
Approval Date
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Annmarie Rainford Dennis, Corporate Compliance Officer
(503) 214-1652
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/10/2019
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