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ROGUE PHARMACIES INC
CH100790 LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
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Covered Entity Details
Entity Name
LA CLINICA DEL VALLE FAMILY HEALTH CARE CENTER INC
Subdivision Name
PHOENIX HEALTH CENTER--LA CLINICA
Type
HRSA-Funded Health Center
340B ID
CH100790
Entity Address
3617 S Pacific Hwy
Medford, OR 97501-8957
Grant Number
H80CS00759
Participating Start Date
1/1/1999
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
ROGUE PHARMACIES INC
Pharmacy Address
DBA: CASCADE PHARMACY
7591A CRATER LAKE HWY
WHITE CITY, OR 97503-1663
Pharmacy Comments
Contract Details
Approval Date
3/7/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/5/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brenda Johnson, CEO
(541) 512-3151
Contract Pharmacy Representative
Corey Donovan, General Manager
(541) 826-4414
Signed By Date
1/15/2013
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