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ARDON HEALTH, LLC
CAH381321-00 Grande Ronde Hospital, Inc.
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Covered Entity Details
Entity Name
Grande Ronde Hospital, Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381321-00
Entity Address
900 Sunset Drive
La Grande, OR 97850
Medicare Provider Number
381321
Participating Start Date
4/1/2013
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
ARDON HEALTH, LLC
Pharmacy Address
11835 NE GLENN WIDING DR
PORTLAND, OR 97220-9057
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Seymour, CFO/Senior Director of Finance
(541) 963-1463
Contract Pharmacy Representative
Ardon Health
Mark Danilin, 340B Program Manager
(503) 444-6573
Signed By Date
4/14/2021
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