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FRED MEYER
CH10792D COUNTY OF LANE
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Covered Entity Details
Entity Name
COUNTY OF LANE
Subdivision Name
Riverstone Clinic
Type
HRSA-Funded Health Center
340B ID
CH10792D
Entity Address
2073 Olympic St
Springfield, OR 97477-3413
Grant Number
H80CS01443
Participating Start Date
4/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
FRED MEYER
Pharmacy Address
SPRINGFIELD STORE
650 Q STREET
SPRINGFIELD, OR 97477
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eve Gray, H&HS Director
(541) 682-3942
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/12/2023
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