Contract Pharmacy Details

ALBERTSONS LLC
CHC24145-00 WALLACE MEDICAL CONCERN, THE

Covered Entity Details

Entity Name

WALLACE MEDICAL CONCERN, THE

Subdivision Name

Wallace Rockwood Clinic

Type

HRSA-Funded Health Center

340B ID

CHC24145-00

Entity Address

18633 SE Stark St.
Suite 401
Portland, OR 97233-5468

Grant Number

H80CS24145

Participating Start Date

4/1/2014

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

ALBERTSONS LLC

Pharmacy Address

SAV-ON PHARMACY #564
451 NE 181ST AVE
PORTLAND, OR 97230

Pharmacy Comments

Contract Details

Approval Date

7/25/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/16/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Lisa Cline, Chief Executive Officer
(503) 907-0591

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

7/25/2016

340B Drug Pricing Program Database