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PROCARE PHARMACY, L.L.C.
DSH380021 TUALITY HEALTHCARE
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Covered Entity Details
Entity Name
TUALITY HEALTHCARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380021
Entity Address
335 SE 8TH AVE
HILLSBORO, OR 97123
Medicare Provider Number
380021
Participating Start Date
7/1/2010
Last Recertification Date
9/2/2024
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
10/5/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lori K James-Nielsen, President
(503) 681-1177
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/5/2020
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