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CREDENA HEALTH LLC
DSH020001 PROVIDENCE ALASKA MEDICAL CENTER
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Covered Entity Details
Entity Name
PROVIDENCE ALASKA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH020001
Entity Address
3200 PROVIDENCE DRIVE
ANCHORAGE, AK 99508
Medicare Provider Number
020001
Participating Start Date
7/1/2005
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH LLC
Pharmacy Address
7376 SW DURHAM RD
PORTLAND, OR 97224
Pharmacy Comments
Contract Details
Approval Date
10/10/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
AMY MILLER, Chief Financial Officer, ALASKA
(907) 212-6503
Contract Pharmacy Representative
Providence
Tammy Pierce, Director of Pharmacy
(503) 962-1700
Signed By Date
10/10/2022
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