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HEALTHY OPTIONS INC
DSH380007 LEGACY EMANUEL HOSPITAL & HEALTH CENTER
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Covered Entity Details
Entity Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380007
Entity Address
2801 N GANTENBEIN AVE
PORTLAND, OR 97227
Medicare Provider Number
380007
Participating Start Date
7/1/2007
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
HEALTHY OPTIONS INC
Pharmacy Address
DBA POSTAL PRESCRIPTION SVCS
3500 SE 26TH AVE
PO BOX 2718
PORTLAND, OR 97202
Pharmacy Comments
Contract Details
Approval Date
1/12/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/25/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Everett W. Newcomb III, Sr Vice President and COO
(503) 415-5252
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/12/2016
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