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FRED MEYER
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
FRED MEYER
Pharmacy Address
1215 W 6TH ST
THE DALLES, OR 97058
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
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
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
7/12/2019
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