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PROCARE PHARMACY, L.L.C.
DSH380060 Portland Adventist Medical Center dba Adventist Health Portland
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Covered Entity Details
Entity Name
Portland Adventist Medical Center dba Adventist Health Portland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380060
Entity Address
10123 SE Market Street
Portland, OR 97216
Medicare Provider Number
380060
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PROCARE PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald E. Welch, CFO
(503) 261-4406
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2022
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