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PROCARE PHARMACY, L.L.C.
CH10112F MULTNOMAH COUNTY
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Covered Entity Details
Entity Name
MULTNOMAH COUNTY
Subdivision Name
SOUTHEAST HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH10112F
Entity Address
3653 SE 34th Ave
Portland, OR 97202-3034
Grant Number
H80CS00149
Participating Start Date
4/1/1995
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11280
538 SW 4TH AVENUE
PORTLAND, OR 97204
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Mark Lewis, Administrator
(503) 988-7462
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2019
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