Contract Pharmacy Details

INDEPENDENCE PHARMACY, INC.
CH10076J NORTHWEST HUMAN SERVICES, INC.

Covered Entity Details

Entity Name

NORTHWEST HUMAN SERVICES, INC.

Subdivision Name

HOST YOUTH & FAMILY PROGRAM

Type

HRSA-Funded Health Center

340B ID

CH10076J

Entity Address

1143 LIBERTY STREET, NE
SALEM, OR 97301

Grant Number

H80CS00148

Participating Start Date

10/1/2004

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

INDEPENDENCE PHARMACY, INC.

Pharmacy Address

DBA: HI-SCHOOL PHARMACY #2700
1357 MONMOUTH ST
INDEPENDENCE, OR 97351-1126

Pharmacy Comments

Contract Details

Approval Date

7/22/2008

Contract Begin Date

7/22/2008

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

7/9/2008

340B Drug Pricing Program Database