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OREGON CVS PHARMACY, L.L.C.
RWIID97232 Oregon Health Authority
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Covered Entity Details
Entity Name
Oregon Health Authority
Subdivision Name
ADAP / CAREAssist
Type
Ryan White Part B ADAP Direct Purchase
340B ID
RWIID97232
Entity Address
800 NE Oregon St.
Suite 1105
Portland, OR 97232
Grant Number
X07HA00007
Participating Start Date
10/1/2011
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
OREGON CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11335
640 SW BROADWAY
PORTLAND, OR 97205
Pharmacy Comments
Contract Details
Approval Date
4/5/2021
Contract Begin Date
5/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Annick Julia Benson-Scott, HIV/STD/TB Section Manager
(971) 673-0142
Contract Pharmacy Representative
CVS PHARMACY, L.L.C.
Andrew Anastasia, Manager
(619) 849-8896
Signed By Date
4/5/2021
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