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OREGON CVS PHARMACY, L.L.C.
DSH380051 Salem Health
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Covered Entity Details
Entity Name
Salem Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380051
Entity Address
890 Oak Street SE
Salem, OR 97301
Medicare Provider Number
380051
Participating Start Date
7/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
OREGON CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 17195
6450 KEIZER STATION BLVD NE
KEIZER, OR 97303
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Josh Free, Chief Pharmacy Officer
(503) 814-2773
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
10/15/2020
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