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DAHISSE INC
CH103100 UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
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Covered Entity Details
Entity Name
UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
Subdivision Name
Umpqua Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH103100
Entity Address
150 NE Kenneth Ford Drive
Roseburg, OR 97470
Grant Number
H80CS00567
Participating Start Date
10/1/2003
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
DAHISSE INC
Pharmacy Address
DBA MYRTLE DRUGS
821 S MAIN ST
MYRTLE CREEK, OR 97457
Pharmacy Comments
Contract Details
Approval Date
1/5/2022
Contract Begin Date
1/7/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leah Woods, Chief Financial Officer
(541) 672-9596 Ext: 120
Contract Pharmacy Representative
Dahisse Inc DBA Myrtle Drugs
Michel Daher, Owner
(541) 391-8321
Signed By Date
1/5/2022
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