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OHSU GABRIEL PARK PHARMACY
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
OHSU GABRIEL PARK PHARMACY
Pharmacy Address
4411 SW VERMONT ST
VERMONT HILLS PLAZA
PORTLAND, OR 97219-1020
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/17/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TIMOTHY L. FLEISCHMANN, CFO
(503) 681-1579
Contract Pharmacy Representative
OHSU
Jennifer Zanon, Director Pharmacy Services; Regulatory Compliance
(503) 418-1286
Signed By Date
10/17/2016
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