Contract Pharmacy Details

OREGON CVS PHARMACY, L.L.C.
FQHCLA405 Cascade Aids Project

Covered Entity Details

Entity Name

Cascade Aids Project

Subdivision Name

Prism Health

Type

Health Center Program Look-Alike

340B ID

FQHCLA405

Entity Address

2236 SE Belmont St
Portland, OR 97214-2817

Grant Number

LALCS33965

Participating Start Date

4/16/2020

Last Recertification Date

2/24/2025

Pharmacy Details

Pharmacy Name

OREGON CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 17632
1555 N TOMAHAWK ISLAND DR
PORTLAND, OR 97217

Pharmacy Comments

Contract Details

Approval Date

4/8/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tyler A. TerMeer, Executive Director
(503) 278-3810

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/8/2020

340B Drug Pricing Program Database