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MEDFORD PHARMACY GROUP, LLC
CH102970 Rogue Community Health
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Covered Entity Details
Entity Name
Rogue Community Health
Subdivision Name
Medford Health Center
Type
HRSA-Funded Health Center
340B ID
CH102970
Entity Address
19 Myrtle St
Medford, OR 97504-7337
Grant Number
H80CS04204
Participating Start Date
9/9/2005
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
MEDFORD PHARMACY GROUP, LLC
Pharmacy Address
DBA: WEST MAIN PHARMACY
2355 W MAIN ST
MEDFORD, OR 97501
Pharmacy Comments
Contract Details
Approval Date
1/9/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WIlliam North, CEO
(541) 223-3172
Contract Pharmacy Representative
Medford Pharmacy Group
Ben Larsen, Pharmacy Director
(360) 562-9192
Signed By Date
1/9/2021
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