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PROCARE PHARMACY, L.L.C.
DSH380007 LEGACY EMANUEL HOSPITAL & HEALTH CENTER
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Covered Entity Details
Entity Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380007
Entity Address
2801 N GANTENBEIN AVE
PORTLAND, OR 97227
Medicare Provider Number
380007
Participating Start Date
7/1/2007
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11280
538 SW 4TH AVENUE
PORTLAND, OR 97204
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/17/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Anna Loomis, SVP Chief Financial Officer
(503) 415-5730
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/10/2020
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