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CREDENA HEALTH, LLC
CAH381308-00 Salem Health West Valley
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Covered Entity Details
Entity Name
Salem Health West Valley
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381308-00
Entity Address
525 SE WASHINGTON STREET
DALLAS, OR 97338-0378
Medicare Provider Number
381308
Participating Start Date
1/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH, LLC
Pharmacy Address
6348 NE HALSEY ST
SUITE A
PORTLAND, OR 97213-4720
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
Providence
Tammy Pierce, Director of Pharmacy
(503) 962-1700
Signed By Date
10/15/2020
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