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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09625
17850 LOWER BOONES FERRY RD
LAKE OSWEGO, OR 97035
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2013
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