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CREDENA HEALTH, LLC
CAH381303-00 PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381303-00
Entity Address
725 S. WAHANNA RD.
SEASIDE, OR 97138-7735
Medicare Provider Number
381303
Participating Start Date
7/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH, LLC
Pharmacy Address
6348 NE HALSEY ST
SUITE A
PORTLAND, OR 97213-4720
Pharmacy Comments
Contract Details
Approval Date
10/12/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
PAMELA J. Cooper, CHIEF FINANCIAL OFFICER
(503) 717-7296
Contract Pharmacy Representative
Debbie Michaelson, Director of Specialty Pharmacy Svcs
(503) 962-1700
Signed By Date
10/12/2015
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