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CREDENA HEALTH LLC
CAH381303-00 PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381303-00
Entity Address
725 S. WAHANNA RD.
SEASIDE, OR 97138-7735
Medicare Provider Number
381303
Participating Start Date
7/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH LLC
Pharmacy Address
7376 SW DURHAM RD
PORTLAND, OR 97224
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pamela Jill Cooper, Director of Finance
(503) 717-2241
Contract Pharmacy Representative
Providence
Tammy Pierce, Director of Pharmacy
(503) 962-1700
Signed By Date
10/13/2022
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