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MEDFORD PHARMACY GROUP, LLC
CH10079AF LA CLINCA DEL VALLE FAMILY HEALTH CENTER INC
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Covered Entity Details
Entity Name
LA CLINCA DEL VALLE FAMILY HEALTH CENTER INC
Subdivision Name
La Clinica School-Based Health Center at Phoenix High School
Type
HRSA-Funded Health Center
340B ID
CH10079AF
Entity Address
745 N Rose St
Phoenix, OR 97535-5704
Grant Number
H80CS00759
Participating Start Date
1/1/2024
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEDFORD PHARMACY GROUP, LLC
Pharmacy Address
DBA: WEST MAIN PHARMACY
2355 W MAIN ST
MEDFORD, OR 97501
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Traci Fossen, Chief Quality Officer
(541) 512-3912
Contract Pharmacy Representative
West Main Pharmacy
Jeff Harell, Managing Member
(541) 772-2330
Signed By Date
1/11/2024
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