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GORDON'S PHARMACY AND GIFTS, LLC
RRC380027-00 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC380027-00
Entity Address
2700 NW STEWART PARKWAY
ROSEBURG, OR 97471
Medicare Provider Number
380027
Participating Start Date
7/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
GORDON'S PHARMACY AND GIFTS, LLC
Pharmacy Address
314 S MAIN ST
CANYONVILLE, OR 97417-9645
Pharmacy Comments
Contract Details
Approval Date
10/31/2012
Contract Begin Date
10/31/2012
Carve-In Effective Date
Contract Comments
7/31/14 Reversed termination done 2 days ago (termination date of 7/1) because it was an error, only contract pharmacies associated with RRC380027-02, -03 and 04 should have been terminated; 7/29/14 Manual termination because database failed to terminate the CP when the CE was terminated, contract termination reason is that the CE was terminated
Contract Termination Date
Termination Reason
1/26/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Kasberger, CFO/CRO
(541) 677-2458
Contract Pharmacy Representative
David Stevens, Owner
(541) 839-4452
Signed By Date
10/15/2012
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