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FRED MEYER STORES INC
CH101310 CLACKAMAS, COUNTY OF
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Covered Entity Details
Entity Name
CLACKAMAS, COUNTY OF
Subdivision Name
Clackamas Health Centers Administration
Type
HRSA-Funded Health Center
340B ID
CH101310
Entity Address
2051 Kaen Road STE 367
Oregon City, OR 97045-4035
Grant Number
H80CS00547
Participating Start Date
4/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
FRED MEYER STORES INC
Pharmacy Address
FRED MEYER PHARMACY #651
1401 SE FIRST AVE
CANBY, OR 97013
Pharmacy Comments
Contract Details
Approval Date
10/10/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DAVID EDWARDS, FQHC DIRECTOR
(503) 742-5325
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/10/2013
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