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PROVIDENCE HEALTH & SERVICES - OREGON
CAH381318-00 PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE HOOD RIVER MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381318-00
Entity Address
810 12th Street
HOOD RIVER, OR 97031-1587
Medicare Provider Number
381318
Participating Start Date
4/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
PROVIDENCE HEALTH & SERVICES - OREGON
Pharmacy Address
PROVIDENCE SPECIALTY PHARMACY SERVICES -
6410 NE HALSEY ST STE 400
PORTLAND, OR 97213-4759
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeanette Carol Vieira, CEO
(541) 387-6456
Contract Pharmacy Representative
Providence
Tammy Pierce, Director of Pharmacy
(503) 962-1700
Signed By Date
10/12/2017
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