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EVERGREEN PHARMACEUTICAL,LLC
CH101020 Sea Mar Community Health Centers
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Covered Entity Details
Entity Name
Sea Mar Community Health Centers
Subdivision Name
Sea Mar CHC - Administration
Type
HRSA-Funded Health Center
340B ID
CH101020
Entity Address
1040 S. Henderson St.
Seattle, WA 98108
Grant Number
H80CS00445
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
EVERGREEN PHARMACEUTICAL,LLC
Pharmacy Address
DBA OMNICARE OF PORTLAND
11933 NE GLENN WIDING DR
PORTLAND, OR 97220-9099
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Bartolo, Executive Vice President
(206) 763-5277
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2023
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