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LUNDGREN
RWII97214B Cascade AIDS Project
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Covered Entity Details
Entity Name
Cascade AIDS Project
Subdivision Name
Type
Ryan White Part B
340B ID
RWII97214B
Entity Address
100 East 33rd Street
Suite 201B
Vancouver, WA 98660
Grant Number
X07HA00083
Participating Start Date
4/1/2017
Last Recertification Date
1/29/2020
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
LUNDGREN
Pharmacy Address
DBA CENTRAL DRUG
538 SW 4TH
PORTLAND, OR 97204
Pharmacy Comments
Contract Details
Approval Date
2/14/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/12/2018
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
SHELLEY BAILEY, CEO
(503) 226-2222
Signed By Date
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