Contract Pharmacy Details

LUNDGREN
CH106290 OUTSIDE IN

Covered Entity Details

Entity Name

OUTSIDE IN

Subdivision Name

OUTSIDE IN

Type

HRSA-Funded Health Center

340B ID

CH106290

Entity Address

1132 SW 13th Ave
Portland, OR 97205-1703

Grant Number

H80CS00243

Participating Start Date

7/1/1995

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

LUNDGREN

Pharmacy Address

DBA CENTRAL DRUG
538 SW 4TH
PORTLAND, OR 97204

Pharmacy Comments

Contract Details

Approval Date

7/18/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/25/2017
Ownership change

Contacts

Covered Entity Signing Official

KATHY OLIVER, CEO
(503) 535-3801

Contract Pharmacy Representative

SHELLEY BAILEY, CEO
(503) 226-2222

Signed By Date

7/18/2017