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FRED MEYER STORES INC
CHC24160-00 Neighborhood Health Center
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Covered Entity Details
Entity Name
Neighborhood Health Center
Subdivision Name
NHC Administration and Pharmacy
Type
HRSA-Funded Health Center
340B ID
CHC24160-00
Entity Address
7320 SW Hunziker Rd STE 300
Portland, OR 97223
Grant Number
H80CS24160
Participating Start Date
1/1/2015
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
FRED MEYER STORES INC
Pharmacy Address
FRED MEYER PHARMACY #330
5253 SE 82ND AVE
PORTLAND, OR 97266
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Blain A. West, CFO / COO
(503) 941-3028
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/17/2017
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