Contract Pharmacy Details

LUNDGREN
RWII97214 Cascade AIDS Project

Covered Entity Details

Entity Name

Cascade AIDS Project

Subdivision Name

Type

Ryan White Part B

340B ID

RWII97214

Entity Address

2236 SE Belmont Street
Portland, OR 97214

Grant Number

X07HA00083

Participating Start Date

4/1/2017

Last Recertification Date

1/29/2020

Entity Termination Date

7/1/2020

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

340B Drug Pricing Program Database