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ARDON HEALTH, LLC
CAH381318-00 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381318-00
Entity Address
810 12th Street
HOOD RIVER, OR 97031-1587
Medicare Provider Number
381318
Participating Start Date
4/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ARDON HEALTH, LLC
Pharmacy Address
11835 NE GLENN WIDING DR
PORTLAND, OR 97220-9057
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeanette Carol Vieira, CEO
(541) 387-6456
Contract Pharmacy Representative
Ardon Health
Grant E Knowles, VP
(503) 444-6501
Signed By Date
7/11/2019
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