Contract Pharmacy Details

DOWNTOWN PHARMACY
RWIID97232 Oregon Health Authority

Covered Entity Details

Entity Name

Oregon Health Authority

Subdivision Name

ADAP / CAREAssist

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID97232

Entity Address

800 NE Oregon St.
Suite 1105
Portland, OR 97232

Grant Number

X07HA00007

Participating Start Date

10/1/2011

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

DOWNTOWN PHARMACY

Pharmacy Address

333 NORTH RIVERSIDE AVE.
MEDFORD, OR 97501

Pharmacy Comments

6/1/11 UPDATED ADDR (WAS SUITE 210)

Contract Details

Approval Date

9/29/2011

Contract Begin Date

10/1/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/17/2016
Pharmacy closed

Contacts

Covered Entity Signing Official

Victor J. Fox, ADAP Manager
(971) 673-0176

Contract Pharmacy Representative

Isaac Wine, Owner
(541) 776-0606

Signed By Date

9/26/2011