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OREGON CVS PHARMACY, L.L.C.
DSH380009 OREGON HLTH SCIENCE CENTER
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Covered Entity Details
Entity Name
OREGON HLTH SCIENCE CENTER
Subdivision Name
UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH380009
Entity Address
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Medicare Provider Number
380009
Participating Start Date
9/1/1993
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OREGON CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16126
9009 SW HALL BLVD
TIGARD, OR 97223
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joe E Ness, SVP and Chief Operating Officer
(503) 720-7616
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/16/2023
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