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FRED MEYER
FQHCLA405 Cascade Aids Project
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Covered Entity Details
Entity Name
Cascade Aids Project
Subdivision Name
Prism Health
Type
Health Center Program Look-Alike
340B ID
FQHCLA405
Entity Address
2236 SE Belmont St
Portland, OR 97214-2817
Grant Number
LALCS33965
Participating Start Date
4/16/2020
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
FRED MEYER
Pharmacy Address
3805 SE HAWTHORNE BLVD
PORTLAND, OR 97214
Pharmacy Comments
Contract Details
Approval Date
10/30/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tyler A. TerMeer, Executive Director
(503) 278-3810
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
10/30/2020
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