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FRED MEYER #040
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
FRED MEYER #040
Pharmacy Address
7555 SW BARBUR BLVD
PORTLAND, OR 97219
Pharmacy Comments
Contract Details
Approval Date
10/16/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DIANA GERNHART, HOSPITAL CFO
(503) 494-8744
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
10/16/2013
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