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INDEPENDENCE PHARMACY, INC.
CH10076H NORTHWEST HUMAN SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HUMAN SERVICES, INC.
Subdivision Name
TOTAL HEALTH COMMUNIITY CLINIC
Type
HRSA-Funded Health Center
340B ID
CH10076H
Entity Address
180 ATWATER STREET, N
MONMOUTH, OR 97361
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
6/23/2008
Contract Begin Date
6/23/2008
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/3/2008
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