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FRED MEYER INC
CH1010810 BENTON COUNTY
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Covered Entity Details
Entity Name
BENTON COUNTY
Subdivision Name
BENTON HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH1010810
Entity Address
530 NW 27th St
Corvallis, OR 97330-5223
Grant Number
H80CS02592
Participating Start Date
7/1/2004
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
FRED MEYER INC
Pharmacy Address
PHARMACY
777 NW KINGS BLVD
CORVALLIS, OR 97330
Pharmacy Comments
Contract Details
Approval Date
10/23/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SHERLYN DAHL, Executive Director
(541) 766-6835
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/23/2013
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