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CREDENA HEALTH PHARMACY TANASBOURNE
CHC24160-08 NEIGHBORHOOD HEALTH CENTER
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Covered Entity Details
Entity Name
NEIGHBORHOOD HEALTH CENTER
Subdivision Name
NHC Tanasbourne Medical & Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CHC24160-08
Entity Address
10690 NE Cornell Rd Ste 220
Hillsboro, OR 97124-9206
Grant Number
H80CS24160
Participating Start Date
7/1/2017
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
CREDENA HEALTH PHARMACY TANASBOURNE
Pharmacy Address
10670 NE CORNELL RD STE 102
HILLSBORO, OR 97124-9221
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Blain A. West, CFO / COO
(503) 941-3028
Contract Pharmacy Representative
Providence St. Joseph Health
Glenn W Wachter, Outpatient Ops Strat Exec Dir, Pharmacy
(503) 962-1743
Signed By Date
10/14/2024
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