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FRED MEYER INC
DSH380021 TUALITY HEALTHCARE
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Covered Entity Details
Entity Name
TUALITY HEALTHCARE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380021
Entity Address
335 SE 8TH AVE
HILLSBORO, OR 97123
Medicare Provider Number
380021
Participating Start Date
7/1/2010
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
FRED MEYER INC
Pharmacy Address
PHARMACY DEPARTMENT
2200 BASE LINE STREET
CORNELIUS, OR 97113
Pharmacy Comments
Contract Details
Approval Date
2/2/2012
Contract Begin Date
2/2/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Manuel Berman, Administrator/Chief Operating Officer
(503) 681-1177
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/26/2012
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