Contract Pharmacy Details

WALGREEN CO.
DSH380025 LEGACY MOUNT HOOD MEDICAL CENTER

Covered Entity Details

Entity Name

LEGACY MOUNT HOOD MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH380025

Entity Address

24800 SE STARK ST
GRESHAM, OR 97030

Medicare Provider Number

380025

Participating Start Date

7/1/2007

Last Recertification Date

9/2/2024

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03817
4285 W POWELL BLVD
GRESHAM, OR 97030

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

10/10/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Anna Loomis, SVP Chief Financial Officer
(503) 415-5730

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/14/2020

340B Drug Pricing Program Database