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US BIOSERVICES
CH103100 UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
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Covered Entity Details
Entity Name
UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
Subdivision Name
Umpqua Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH103100
Entity Address
150 NE Kenneth Ford Drive
Roseburg, OR 97470
Grant Number
H80CS00567
Participating Start Date
10/1/2003
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
US BIOSERVICES
Pharmacy Address
US BIOSERVICE CORPORATION
5025 PLANO PARKWAY
STE 100
CARROLLTON, TX 75010
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/22/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
KC Bolton, CEO
(541) 672-9596 Ext: 103
Contract Pharmacy Representative
US Bioservices
Mischelle Smoot, Pharmacist-in-Charge
(888) 518-7246
Signed By Date
10/17/2016
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