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PROCARE PHARMACY, L.L.C.
DSH380009 OREGON HLTH SCIENCE CENTER
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Covered Entity Details
Entity Name
OREGON HLTH SCIENCE CENTER
Subdivision Name
UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH380009
Entity Address
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Medicare Provider Number
380009
Participating Start Date
9/1/1993
Last Recertification Date
9/6/2024
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
DIANA GERNHART, HOSPITAL CFO
(503) 494-8744
Contract Pharmacy Representative
CVS Health
Christian Reid, Senior Director of 340B
(401) 770-2118
Signed By Date
4/14/2020
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