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WAL-MART PHARMACY 10-2477
CH10310E UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
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Covered Entity Details
Entity Name
UMPQUA COMMUNITY HEALTH CENTER, INC., dba Aviva Health
Subdivision Name
GLIDE CLINIC
Type
HRSA-Funded Health Center
340B ID
CH10310E
Entity Address
20170 NORTH UMPQUA HIGHWAY
GLIDE, OR 97443
Grant Number
H80CS00567
Participating Start Date
10/1/2007
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2477
Pharmacy Address
2125 NW STEWART PKWY
ROSEBURG, OR 97471
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leah Woods, Chief Financial Officer
(541) 672-9596 Ext: 120
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
10/13/2023
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