Contract Pharmacy Details

LUNDGREN
CH10766C CENTRAL CITY CONCERN

Covered Entity Details

Entity Name

CENTRAL CITY CONCERN

Subdivision Name

Old Town Clinic

Type

HRSA-Funded Health Center

340B ID

CH10766C

Entity Address

727 W BURNSIDE AVE
PORTLAND, OR 97209-3514

Grant Number

H80CS00234

Participating Start Date

4/1/2004

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

LUNDGREN

Pharmacy Address

DBA CENTRAL DRUG
538 SW 4TH
PORTLAND, OR 97204

Pharmacy Comments

Contract Details

Approval Date

8/19/2004

Contract Begin Date

8/19/2004

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/10/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

340B Drug Pricing Program Database