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PROVIDENCE HEALTH & SERVICES - OREGON
DSH380038 PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER
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Covered Entity Details
Entity Name
PROVIDENCE WILLAMETTE FALLS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380038
Entity Address
1500 DIVISION STREET
OREGON CITY, OR 97045
Medicare Provider Number
380038
Participating Start Date
7/1/2015
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
PROVIDENCE HEALTH & SERVICES - OREGON
Pharmacy Address
PROVIDENCE PLAZA PHARMACY
5050 NE HOYT STREET
SUITE #142
PORTLAND, OR 97213
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Ownership change
Contacts
Covered Entity Signing Official
Russell P. Reinhard, Chief Executive
(503) 657-6915
Contract Pharmacy Representative
Providence. Health & Services
John Evans, Director, Retail Ops
(503) 215-6296
Signed By Date
1/12/2018
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