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GENOA HEALTHCARE LLC
DSH380009 OREGON HLTH SCIENCE CENTER
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Covered Entity Details
Entity Name
OREGON HLTH SCIENCE CENTER
Subdivision Name
UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH380009
Entity Address
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Medicare Provider Number
380009
Participating Start Date
9/1/1993
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
18417 SE OAK STREET
PORTLAND, OR 97233
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DIANA GERNHART, HOSPITAL CFO
(503) 494-8744
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Sr VP of Strategic Sales
(651) 983-0677
Signed By Date
4/13/2021
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