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HOME TOWN DRUGS OF SUTHERLIN INC
CH103100 UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
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Covered Entity Details
Entity Name
UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
Subdivision Name
Umpqua Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH103100
Entity Address
150 NE Kenneth Ford Drive
Roseburg, OR 97470
Grant Number
H80CS00567
Participating Start Date
10/1/2003
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
HOME TOWN DRUGS OF SUTHERLIN INC
Pharmacy Address
DBA: SUTHERLIN DRUG
113 E CENTRAL AVE
SUTHERLIN, OR 97479-9556
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/5/2023
Ownership change
Contacts
Covered Entity Signing Official
KC Bolton, CEO
(541) 672-9596 Ext: 103
Contract Pharmacy Representative
Hometown Drugs of Sutherlin Inc dba Sutherlin Drug
Ashley Peterman, Chief Operations Officer
(541) 459-2712
Signed By Date
1/14/2021
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