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OREGON CVS PHARMACY, L.L.C.
CH10079C LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
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Covered Entity Details
Entity Name
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Subdivision Name
WEST MEDFORD HEALTH CENTER--La Clinica
Type
HRSA-Funded Health Center
340B ID
CH10079C
Entity Address
1307 W Main St
Medford, OR 97501-2936
Grant Number
H80CS00759
Participating Start Date
4/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
OREGON CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16159
2000 CRATER LAKE HWY
MEDFORD, OR 97504
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2024
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