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FRED MEYER INC
CH106280 YAKIMA VALLEY FARM WORKERS CLINIC
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Covered Entity Details
Entity Name
YAKIMA VALLEY FARM WORKERS CLINIC
Subdivision Name
COASTAL FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH106280
Entity Address
2158 Exchange St STE 304
Astoria, OR 97103-3419
Grant Number
H80CS00639
Participating Start Date
4/1/2003
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
FRED MEYER INC
Pharmacy Address
DBA FRED MEYER
695 HWY 101
WARRENTON, OR 97146
Pharmacy Comments
Contract Details
Approval Date
1/7/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/9/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
WENDY GILMORE, CFO
(503) 325-8315 Ext: 219
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/7/2016
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