Contract Pharmacy Details

PHARMBLUE OREGON LLC
RWII97403B HIV Alliance

Covered Entity Details

Entity Name

HIV Alliance

Subdivision Name

Marion County Office

Type

Ryan White Part B

340B ID

RWII97403B

Entity Address

3886 Beverly Ave. NE
Building I, Suite 6
Salem, OR 97305

Grant Number

X07HA00007

Participating Start Date

4/1/2020

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE OREGON LLC

Pharmacy Address

140 S HOLLY ST
SUITE 1131
MEDFORD, OR 97501-3113

Pharmacy Comments

Contract Details

Approval Date

4/13/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/1/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Renee Yandel, Executive Director
(541) 342-5088 Ext: 118

Contract Pharmacy Representative

PharmBlue
Gabriel Santry, Director of National Accounts
(724) 779-4720 Ext: 017

Signed By Date

4/13/2020

340B Drug Pricing Program Database