340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTION CARE LEGACY HEALTH, LLC
DSH380017 LEGACY GOOD SAMARITAN HOSPITAL
Print
Covered Entity Details
Entity Name
LEGACY GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380017
Entity Address
1015 NW 22ND AVENUE
PORTLAND, OR 97210
Medicare Provider Number
380017
Participating Start Date
10/1/2016
Last Recertification Date
9/2/2024
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
1/5/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Everett W. Newcomb III, Sr Vice President and COO
(503) 415-5252
Contract Pharmacy Representative
Option Care
Jon Adair, Vice President, Health System Solutions
(847) 830-9996
Signed By Date
1/5/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session