Contract Pharmacy Details

WALGREEN CO.
DSH380009 OREGON HLTH SCIENCE CENTER

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 #16251
7070 NE SANDY BLVD
PORTLAND, OR 97213

Pharmacy Comments

Contract Details

Approval Date

7/18/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/14/2022
Pharmacy closed

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

7/18/2017

340B Drug Pricing Program Database