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THRIFTY PAYLESS, INC.
DSH380060 Portland Adventist Medical Center dba Adventist Health Portland
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Covered Entity Details
Entity Name
Portland Adventist Medical Center dba Adventist Health Portland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380060
Entity Address
10123 SE Market Street
Portland, OR 97216
Medicare Provider Number
380060
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5357
514 NE 181ST AVENUE
PORTLAND, OR 97230
Pharmacy Comments
Contract Details
Approval Date
1/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/7/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Donald E. Welch, CFO
(503) 261-4406
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/12/2021
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