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OREGON CVS PHARMACY, L.L.C.
DSH380029 SILVERTON HEALTH DBA LEGACY SILVERTON MEDICAL CENTER OR SILVERTON HEALTH
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Covered Entity Details
Entity Name
SILVERTON HEALTH DBA LEGACY SILVERTON MEDICAL CENTER OR SILVERTON HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380029
Entity Address
342 FAIRVIEW STREET
SILVERTON, OR 97381-1993
Medicare Provider Number
380029
Participating Start Date
1/1/2019
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
OREGON CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16154
3790 CENTER ST NE
SALEM, OR 97301
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
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
4/14/2020
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