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OPTION CARE LEGACY HEALTH, LLC
DSH380060 Portland Adventist Medical Center dba Adventist Health Portland
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Covered Entity Details
Entity Name
Portland Adventist Medical Center dba Adventist Health Portland
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380060
Entity Address
10123 SE Market Street
Portland, OR 97216
Medicare Provider Number
380060
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
OPTION CARE LEGACY HEALTH, LLC
Pharmacy Address
D/B/A OPTION CARE AT LEGACY HEALTH
16195 S.W. 72ND AVENUE
PORTLAND, OR 97224-7766
Pharmacy Comments
Contract Details
Approval Date
1/26/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/4/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Don Welch, CFO
(503) 261-4406
Contract Pharmacy Representative
Option Care
Jon Adair, Vice President, Health System Solutions
(847) 830-9996
Signed By Date
1/26/2016
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