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OHSU PHARMACY AT ADVENTIST
DSH380060 Portland Adventist Medical Center dba Adventist Health Portland
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Covered Entity Details
Entity Name
Portland Adventist Medical Center dba Adventist Health Portland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380060
Entity Address
10123 SE Market Street
Portland, OR 97216
Medicare Provider Number
380060
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OHSU PHARMACY AT ADVENTIST
Pharmacy Address
10000 SE MAIN ST STE 118
PORTLAND, OR 97216-2462
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aaron Poole, VP & CFO
(503) 261-4406 Ext: 11506
Contract Pharmacy Representative
OHSU
Bob Stueber, Contract Specialist
(503) 494-8007
Signed By Date
4/15/2019
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