Covered Entity Details

CH10102S Sea Mar Community Health Centers (Active) - information as of 4/25/2025 6:34:14 PM

Main Details

Name

Sea Mar Community Health Centers

Subdivision Name

Sea Mar CHC - Marysville State Ave.

Type

HRSA-Funded Health Center

Site ID

BPS-H80-003850

340B ID

CH10102S

Grant Number

H80CS00445

Additional Details

Current Program Status

Active

Registration Date

7/1/2003

Participating Start Date

7/1/2003

Participating Approval Date

1/22/2010

Last Recertification Date

2/17/2025

Contacts

Authorizing Official

Sea Mar Community Health Centers
Mary Bartolo, Executive Vice President
(206) 763-5277

Primary Contact

Sea-Mar
Luz Maria Colberg, Purchasing Specialist
(206) 788-3202

Addresses

Street Address

9710 State Ave
Marysville, WA 98270

Billing Address

SEA MAR COMMUNITY HEALTH CENTER
1040 S. HENDERSON STREET
SEATTLE, WA 98108

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
2/18/08 ADDED BILL TO;	01/22/2010

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
WA	1013748,2004848,2204603,2058406,2044533,2059683,2031302,2086057,2214235,2012247,2083152,1054624,1045030,2045359,2081423,2107202,2203608,1008573,2305429	1578610911,1730340753,1881359206,1417312828,1972606333,1750737193,1598190597,1861922387,1265180129,1356640437,1952831471,1114113602,1639237142,1932587854,1083153233,1801372768,1033782149,1952141582,1356487318,1437965589

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	FRED MEYER STORES	9925 STATE AVENUE		MARYSVILLE	WA	98270	10/11/2023	01/01/2024			01/01/2024
Contract Detail	HAGGEN, INC.	HAGGEN FOOD & PHARMACY #77	3711 88TH STREET NE	MARYSVILLE	WA	98270	03/08/2010	03/08/2010		09/30/2022	10/14/2022

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH101020	Active	BPS-H80-000104	Sea Mar Community Health Centers	Sea Mar CHC - Administration	1040 S. Henderson St.	Seattle	WA
CH10102A	Active	BPS-H80-001468	Sea Mar Community Health Centers	Sea Mar CHC - Mt. Vernon N. LaVenture Rd.	1400 N LAVENTURE RD	MOUNT VERNON	WA
CH10102AE	Active	BPS-H80-003741	Sea Mar Community Health Centers	Sea Mar CHC - Burien Ambaum Blvd. SW	14434 Ambaum Blvd SW	Burien	WA
CH10102AG	Active	BPS-H80-008046	Sea Mar Community Health Centers	Sea Mar CHC - Bellevue 156th Ave. NE	1811 156th Avenue NE STE 2	Bellevue	WA
CH10102AX	Active	BPS-H80-004935	Sea Mar Community Health Centers	Sea Mar CHC - White Center 15th Ave. SW	9650 15TH AVE SW # 100	SEATTLE	WA
CH10102AY	Active	BPS-H80-015199	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver NE 20th Ave.	14508 NE 20th Ave.,	Vancouver	WA
CH10102AZ	Active	BPS-H80-008047	Sea Mar Community Health Centers	Sea Mar CHC - Monroe W. Main St.	17707 W Main Street	Monroe	WA
CH10102BA	Active	BPS-H80-018799	Sea Mar Community Health Centers	Sea Mar CHC - Skagit Valley Women's Health Center	125 N. 18th St. Suite A	Mount Vernon	WA
CH10102BC	Active	BPS-H80-009600	Sea Mar Community Health Centers	Sea Mar CHC - Lacey Woodland Square Loop	669 Woodland Square Loop SE	Lacey	WA
CH10102BD	Active	BPS-H80-010999	Sea Mar Community Health Centers	Sea Mar CHC - Des Moines S. 242nd St.	2781 S. 242nd Street	Des Moines	WA
CH10102BE	Active	BPS-H80-010958	Sea Mar Community Health Centers	Sea Mar CHC - Tillicum Community Center	14916 Washington Ave. SW	Lakewood	WA
CH10102BF	Active	BPS-H80-011495	Sea Mar Community Health Centers	Sea Mar CHC - Everett 100th St. SE	1920 100th St SE	Everett	WA
CH10102BG	Active	BPS-H80-000889	Sea Mar Community Health Centers	Sea Mar CHC - Burien 8th Ave. S.	18010 8th Ave S STE 416	Burien	WA
CH10102BH	Active	BPS-H80-000980	Sea Mar Community Health Centers	Sea Mar CHC - Seattle 8915 14th Ave. S.	8915 14th Ave S	Seattle	WA
CH10102BJ	Active	BPS-H80-002641	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver NE 88th St.	1412 NE 88TH ST	VANCOUVER	WA
CH10102BK	Terminated	BPS-H80-002529	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Oak Harbor 31775 SR 20	31775 Sr 20 STE A3	Oak Harbor	WA
CH10102BL	Terminated	BPS-H80-001257	SEA-MAR COMMUNITY HEALTH CENTER	SEA MAR CHC - TUMWATER DENTAL & OUTPATIENT	409 CUSTER WAY SE STE A & C	TUMWATER	WA
CH10102BM	Terminated	BPS-H80-003869	SEA-MAR COMMUNITY HEALTH CENTER	SEA MAR CHC - Tacoma S. 11Th. St.	1516 S 11th St	Tacoma	WA
CH10102BN	Active	BPS-H80-028289	Sea Mar Community Health Centers	Sea Mar CHC - Seattle 8801 14th Ave S	8801 14th Ave. S.	SEATTLE	WA
CH10102BP	Terminated	BPS-H80-007521	SEA-MAR COMMUNITY HEALTH CENTER	SEA MAR CHC - LYNNWOOD OUTPATIENT	19707 44th Ave W	Lynnwood	WA
CH10102BQ	Terminated	BPS-H80-007542	SEA-MAR COMMUNITY HEALTH CENTER	SEA MAR CHC - BELLEVUE OUTPATIENT	12835 NE Bell-Red Road BLDG 100	Bellevue	WA
CH10102BR	Active	BPS-H80-009566	Sea Mar Community Health Centers	Sea Mar CHC - Anacortes M Avenue	1004 M Avenue STE 107	Anacortes	WA
CH10102BS	Active	BPS-H80-009939	Sea Mar Community Health Centers	Sea Mar CHC - Everett Claremont Way	5007 Claremont Way	Everett	WA
CH10102BT	Terminated	BPS-H80-010569	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Monroe Fryelands Blvd. SE	14090 Fryelands Blvd SE	Monroe	WA
CH10102BU	Active	BPS-H80-010324	Sea Mar Community Health Centers	Sea Mar CHC - Puyallup 101st Avenue Ct. E.	12812 101st Avenue Ct E	Puyallup	WA
CH10102BV	Terminated	BPS-H80-018054	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Community Youth Services	520 Pear St. SE	Olympia	WA
CH10102BX	Active	BPS-H80-011245	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver 7803 NE Fourth Plain Rd.	7803 NE Fourth Plain Rd	Vancouver	WA
CH10102BY	Terminated	BPS-H80-011956	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Kent Behavioral Health	1601 W. Meeker St.	Kent	WA
CH10102BZ	Active	BPS-H80-013230	Sea Mar Community Health Centers	Sea Mar CHC - Yelm Cullens St. NW	202 Cullens St. NW	Yelm	WA
CH10102CA	Active	BPS-H80-013492	Sea Mar Community Health Centers	Sea Mar CHC - Port Angeles W. 1st St.	228 W 1st St STE K & L	Port Angeles	WA
CH10102CB	Terminated	BPS-H80-018055	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Gig Harbor 50th St Ct NW	3208 50th St Ct NW, Suite 202-203	Gig Harbor	WA
CH10102CC	Terminated	BPS-H80-013745	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Olympia Ensign Rd NE	3622 Ensign Rd NE	Olympia	WA
CH10102CE	Active	BPS-H80-013855	Sea Mar Community Health Centers	Sea Mar CHC - Kent 233 2nd Ave. S.	233 2nd Ave. S.	Kent	WA
CH10102CF	Active	BPS-H80-013881	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver NE 65th St.	11801 NE 65th St.	Vancouver	WA
CH10102CG	Active	BPS-H80-013854	Sea Mar Community Health Centers	Sea Mar CHC - Tacoma S. 19th St.	2121 S. 19th St.	Tacoma	WA
CH10102CH	Terminated	BPS-H80-014019	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Tacoma BH PPW	1119 TACOMA AVE S	TACOMA	WA
CH10102CJ	Active	BPS-H80-013986	Sea Mar Community Health Centers	Sea Mar CHC - Tacoma 1215 S. 11th St.	1215 S 11TH ST	TACOMA	WA
CH10102CK	Terminated	BPS-H80-014067	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Oak Harbor BH	31640 STATE ROUTE 20	OAK HARBOR	WA
CH10102CL	Active	BPS-H80-014169	Sea Mar Community Health Centers	Sea Mar CHC - Bellingham Behavioral Health	3350 AIRPORT DR	BELLINGHAM	WA
CH10102CM	Active	BPS-H80-014063	Sea Mar Community Health Centers	Sea Mar CHC - Concrete	7438 S D AVE	CONCRETE	WA
CH10102CN	Terminated	BPS-H80-014210	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Vancouver Behavioral Health	5501 NE 109TH CT	VANCOUVER	WA
CH10102CP	Terminated	BPS-H80-017032	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Mercy Housing Olympia	1209 Fern Street SW	Olympia	WA
CH10102CQ	Terminated	BPS-H80-016933	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Mercy Housing Bellingham	512 Sterling Drive	Bellingham	WA
CH10102CR	Terminated	BPS-H80-016942	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Mercy Housing Kent	25818 26th Place South	Kent	WA
CH10102CS	Active	BPS-H80-016925	Sea Mar Community Health Centers	Sea Mar CHC - Bellevue 150th Ave. SE	3801 150TH AVE SE	BELLEVUE	WA
CH10102CT	Active	BPS-H80-016940	Sea Mar Community Health Centers	Sea Mar CHC - Elma W. Main St.	515 W. Main St.	Elma	WA
CH10102CU	Active	BPS-H80-016965	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver Fourth Plain	6100 NE Fourth Plain Blvd.	Vancouver	WA
CH10102CV	Active	BPS-H80-017451	Sea Mar Community Health Centers	Sea Mar CHC - Battle Ground	118 S. Parkway Ave.	Battle Ground	WA
CH10102CW	Terminated	BPS-H80-010574	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar CHC - Bellevue 116th Ave. NE	2000 116th Ave. NE	Bellevue	WA
CH10102CX	Active	BPS-H80-017452	Sea Mar Community Health Centers	Sea Mar CHC - Kelso Allen St.	1710 Allen St.	Kelso	WA
CH10102CY	Active	BPS-H80-017450	Sea Mar Community Health Centers	Sea Mar CHC - Tumwater 6334 Littlerock Rd. SW	6334 Littlerock Rd. SW	Tumwater	WA
CH10102CZ	Active	BPS-H80-017453	Sea Mar Community Health Centers	Sea Mar CHC - Tumwater 6336 Littlerock Rd. SW	6336 Littlerock Rd. SW	Tumwater	WA
CH10102DA	Active	BPS-H80-017943	Sea Mar Community Health Centers	Sea Mar CHC - Marysville Grove St. NE	4922 Grove St.	Marysville	WA
CH10102DB	Active	BPS-H80-018604	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver 34th St.	19005 SE 34th St.	Vancouver	WA
CH10102DC	Active	BPS-H80-018504	Sea Mar Community Health Centers	Sea Mar CHC - Tacoma S. Cedar St.	3712 S. Cedar St.	Tacoma	WA
CH10102DD	Active	BPS-H80-018796	Sea Mar Community Health Centers	Sea Mar CHC - Lynnwood Alderwood Mall Blvd.	4111 Alderwood Mall Blvd	Lynnwood	WA
CH10102DE	Active	BPS-H80-018798	Sea Mar Community Health Centers	Sea Mar CHC - Tacoma 1307 S. 11th St.	1307 S. 11th St.	Tacoma	WA
CH10102DF	Active	BPS-H80-019240	Sea Mar Community Health Centers	Sea Mar CHC - Federal Way 18th Ave S	31405 18th Ave. S.	Federal Way	WA
CH10102DG	Active	BPS-H80-021809	Sea Mar Community Health Centers	Sea Mar CHC - Mt. Vernon Old Hwy 99	2203 Old Highway 99 S Rd	Mount Vernon	WA
CH10102DH	Active	BPS-H80-021899	Sea Mar Community Health Centers	Sea Mar CHC - Tacoma S 14th St	702 S 14th St	Tacoma	WA
CH10102DJ	Active	BPS-H80-021858	Sea Mar Community Health Centers	Sea Mar CHC - Kent 104th Ave SE	25028 104th Ave SE	Kent	WA
CH10102DK	Terminated	BPS-H80-027111	Sea-Mar Community Health Center	Sea Mar CHC - Battle Ground NE 189th St.	11117 NE 189th St	Battle Ground	WA
CH10102DL	Active	BPS-H80-027107	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver 317 E 39th St	317 E 39th St	Vancouver	WA
CH10102DM	Terminated	BPS-H80-027399	Sea-Mar Community Health Center	Sea Mar CHC - Tacoma 6th Ave	1112 6th Ave STE 301	Tacoma	WA
CH10102DN	Terminated	BPS-H80-027110	Sea-Mar Community Health Center	Sea Mar CHC - Vancouver 5411 E. Mill Plain Blvd.	5411 E Mill Plain Blvd	Vancouver	WA
CH10102DP	Terminated	BPS-H80-027398	Sea-Mar Community Health Center	Sea Mar CHC – Everett W Mukilteo Blvd	215 W Mukilteo Blvd	Everett	WA
CH10102DQ	Active	BPS-H80-027109	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver 1601 E Fourth Plain Blvd	1601 E Fourth Plain Blvd BLDG 17	Vancouver	WA
CH10102DS	Active	BPS-H80-027208	Sea Mar Community Health Centers	Sea Mar CHC - Seattle Des Moines Memorial Drive S	9635 Des Moines Memorial Dr S	Seattle	WA
CH10102DT	Active	BPS-H80-027209	Sea Mar Community Health Centers	Sea Mar CHC - Bellevue 116th Ave. NE	2000 116th Ave. NE	Bellevue	WA
CH10102DU	Active	BPS-H80-027741	Sea Mar Community Health Centers	Sea Mar CHC - Lakewood Bridgeport Way W	7424 Bridgeport Way W	Lakewood	WA
CH10102DV	Terminated	BPS-H80-028289	Sea-Mar Community Health Center	Sea Mar CHC - Seattle 8801 14th Ave S	8801 14th Ave. S.	Seattle	WA
CH10102DW	Terminated	BPS-H80-027892	Sea-Mar Community Health Center	Sea Mar CHC - Auburn 12th St. SE	735 12th St SE Fl 1	Auburn	WA
CH10102DX	Active	BPS-H80-029717	Sea Mar Community Health Centers	Sea Mar CHC - Tumwater Capitol Blvd SE	6004 Capitol Blvd SE	Tumwater	WA
CH10102DY	Active	BPS-H80-023388	Sea Mar Community Health Centers	Sea Mar CHC - Gig Harbor 50th St Ct NW	3208 50th St Ct, Suite 202-203	Gig Harbor	WA
CH10102DZ	Active	BPS-H80-024906	Sea Mar Community Health Centers	Sea Mar CHC - Olympia Ensign Rd NE	3622 Ensign Rd NE	Olympia	WA
CH10102E	Active	BPS-H80-000987	Sea Mar Community Health Centers	Sea Mar CHC - Everson Hannegan Rd.	6884 Hannegan Rd	Everson	WA
CH10102EA	Active	BPS-H80-030441	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver Evergreen High School	14300 NE 18th St Rm 213	Vancouver	WA
CH10102EB	Active	BPS-H80-031485	Sea Mar Community Health Centers	Sea Mar CHC - Vashon Island	10030 SW 210th St	Vashon	WA
CH10102EC	Terminated	BPS-H80-031117	Sea-Mar Community Health Center	Sea Mar CHC - Lynnwood 194th St. SW	4100 194th St SW Ste 120	Lynnwood	WA
CH10102ED	Active	BPS-H80-030997	Sea Mar Community Health Centers	Sea Mar CHC - Spanaway 176th St. S.	225 176th St S	Spanaway	WA
CH10102EE	Active	BPS-H80-031677	Sea Mar Community Health Centers	Sea Mar CHC - Auburn N. Division St.	202 N Division St Ste 300	Auburn	WA
CH10102EF	Terminated	BPS-H80-032285	Sea-Mar Community Health Center	Sea Mar CHC - Vancouver Grand Blvd.	2018 Grand Blvd	Vancouver	WA
CH10102EG	Terminated	BPS-H80-032011	Sea-Mar Community Health Center	Sea Mar CHC - Kent State Ave. N.	219 State Ave N Ste 220	Kent	WA
CH10102EH	Active	BPS-H80-035153	Sea Mar Community Health Centers	Sea Mar CHC - 2502 E. Fourth Plain Blvd.	2502 E. Fourth Plain Blvd.	Vancouver	WA
CH10102EJ	Active	BPS-H80-034879	Sea Mar Community Health Centers	Sea Mar CHC - Oak Harbor SE Ireland St.	830 SE Ireland St	Oak Harbor	WA
CH10102EK	Active	BPS-H80-035559	Sea Mar Community Health Centers	Sea Mar CHC - Mobile Van #1	1040 S Henderson St.	Seattle	WA
CH10102EL	Active	BPS-H80-036014	Sea Mar Community Health Centers	Sea Mar CHC - Auburn Mountainview High School	28900 124th Ave. SE	Auburn	WA
CH10102EM	Active	BPS-H80-037200	Sea Mar Community Health Centers	Sea Mar CHC - Oak Harbor E. Whidbey Ave.	926 E Whidbey Ave	Oak Harbor	WA
CH10102EN	Active	BPS-H80-038914	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver NE 87th Ave.	816 NE 87th Ave	Vancouver	WA
CH10102EP	Active	BPS-H80-038643	Sea Mar Community Health Centers	Sea Mar CHC - Monroe W. Main St.	800 W Main St	Monroe	WA
CH10102EQ	Active	BPS-H80-039454	SEA MAR COMMUNITY HEALTH CENTERS	Sea Mar CHC - Tacoma Lincoln High School	701 S 37th St	Tacoma	WA
CH10102ER	Active	BPS-H80-039115	SEA MAR COMMUNITY HEALTH CENTERS	Sea Mar CHC - Mobile Van #2	1040 S Henderson St	Seattle	WA
CH10102ES	Active	BPS-H80-039357	SEA MAR COMMUNITY HEALTH CENTERS	Sea Mar CHC - Everett Mall Way	15 SW Everett Mall Way	Everett	WA
CH10102ET	Approved	BPS-H80-039650	SEA MAR COMMUNITY HEALTH CENTERS	Sea Mar CHC - Deming Mt. Baker High School	4936 Deming Rd	Deming	WA
CH10102G	Active	BPS-H80-000992	Sea Mar Community Health Centers	SEA MAR CHC - Bellingham Cordata Parkway	4455 CORDATA PKWY	BELLINGHAM	WA
CH10102H	Active	BPS-H80-009102	Sea Mar Community Health Centers	Sea Mar CHC - Mt. Vernon E. College Way	1010 E College Way	Mount Vernon	WA
CH10102M	Active	BPS-H80-000484	Sea Mar Community Health Centers	Sea Mar CHC - Seattle 8720 14th Ave. S.	8720 14th Ave S	Seattle	WA
CH10102N	Active	BPS-H80-000685	Sea Mar Community Health Centers	Sea Mar CHC - Vancouver Delaware Lane	7410 Delaware Ln	Vancouver	WA
CH10102O	Active	BPS-H80-004051	Sea Mar Community Health Centers	Sea Mar CHC - Aberdeen Sumner Ave.	1813 SUMNER AVE	ABERDEEN	WA
CH10102Q	Active	BPS-H80-003703	Sea Mar Community Health Centers	Sea Mar CHC - Olympia 3030 Limited Lane NW	3030 LIMITED LN NW	OLYMPIA	WA
CH10102R	Active	BPS-H80-000985	Sea Mar Community Health Centers	Sea Mar CHC - Tacoma S. Cushman Ave.	1112 S Cushman Ave	Tacoma	WA
CH10102S	Active	BPS-H80-003850	Sea Mar Community Health Centers	Sea Mar CHC - Marysville State Ave.	9710 State Ave	Marysville	WA
CH10102W	Active	BPS-H80-000203	Sea Mar Community Health Centers	Sea Mar CHC - Puyallup 125th Street Ct. E.	10217 125th Street Ct E	Puyallup	WA
CH10102Z	Active	BPS-H80-010048	Sea Mar Community Health Centers	Sea Mar CHC - Ocean Shores Point Brown Ave.	597 Point Brown Ave NW	Ocean Shores	WA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH101020	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/01/2022
CH101020	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/01/2022
CH101020	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/01/2022
CH101020	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/01/2022	07/01/2023
CH101020	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/01/2022
CH101020	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/01/2022
CH101020	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/01/2022
CH101020	ALBERTSON'S LLC	SAFEWAY PHARMACY #1461	520 128TH ST., SW	EVERETT	WA	98204	04/01/2017	03/05/2022
CH101020	ALBERTSON'S LLC	SAV-ON PHARMACY #478	6727 EVERGREEN WAY	EVERETT	WA	98203	04/01/2017	03/15/2018
CH101020	ALBERTSON'S LLC	SAV-ON PHARMACY #2592	2108 W. MAIN STREET	BATTLE GROUND	WA	98604	04/01/2017
CH101020	ALBERTSON'S LLC	SAFEWAY PHARMACY #1407	705 TROSPER ROAD S.W.	TUMWATER	WA	98512	04/01/2017
CH101020	ALBERTSON'S LLC	SAFEWAY PHARMACY #1413	3322 132ND ST SE	MILL CREEK	WA	98012	04/01/2017	03/05/2022
CH101020	ALBERTSON'S LLC	SAV-ON PHARMACY #493	104 MILLITARY ROAD SOUTH	TACOMA	WA	98444	04/01/2017
CH101020	ALBERTSON'S LLC	SAFEWAY PHARMACY #580	14300 N.E. 20TH AVE.	VANCOUVER	WA	98686	04/01/2017
CH101020	ALBERTSON'S LLC	SAFEWAY PHARMACY #414	4301 212TH ST SW	MOUNTLAKE TERRACE	WA	98043-3585	04/01/2017	03/05/2022
CH101020	ALBERTSON'S LLC	SAV-ON PHARMACY #471	301 MARYSVILLE MALL #60	MARYSVILLE	WA	98270	04/01/2017
CH101020	ALBERTSON'S LLC	SAV-ON PHARMACY #3417	3520 PACIFIC AVE SE	OLYMPIA	WA	98501	04/01/2018
CH10102DA	ALBERTSON'S LLC	SAV-ON PHARMACY #471	301 MARYSVILLE MALL #60	MARYSVILLE	WA	98270	01/01/2024
CH101020	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2019
CH101020	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	04/01/2025
CH101020	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2019
CH101020	BARTELL DRUGS #06908	9600 15TH S.W		SEATTLE	WA	98106	01/01/2014	09/28/2023
CH101020	BARTELL DRUGS #06925	11020 19TH AVE SE		EVERETT	WA	98208-5155	01/01/2017	09/05/2023
CH101020	BARTELL DRUGS #06941	14901 4TH AVENUE SW SUITE 100		BURIEN	WA	98166	04/01/2015
CH10102BN	BARTELL DRUGS #06941	14901 4TH AVENUE SW SUITE 100		BURIEN	WA	98166	01/01/2024
CH101020	BARTELL DRUGS #06943	14277 PACIFIC HIGHWAY SOUTH		TUKWILA	WA	98168	07/01/2022	01/09/2024
CH10102BH	BARTELL DRUGS #06943	14277 PACIFIC HIGHWAY SOUTH		TUKWILA	WA	98168	01/01/2024
CH101020	BARTELL DRUGS #06951	6602- 64TH STREET N.E.		MARYSVILLE	WA	98270	04/01/2015
CH101020	BARTELL DRUGS #06954	3601-6TH AVENUE		TACOMA	WA	98406	01/01/2017
CH101020	BARTELL DRUGS #06959	653 156TH AVE NE		BELLEVUE	WA	98007-4823	04/01/2015
CH101020	BARTELL DRUGS #06991	4420 76TH STREET NE		MARYSVILLE	WA	98270-3726	01/01/2017	02/27/2023
CH101020	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2019
CH101020	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	10/01/2024
CH101020	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	10/01/2024
CH101020	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	10/01/2024
CH101020	CAMP RILEY DRUG INC DBA PHARMASAVE MONRO	17788 147TH ST SE		MONROE	WA	98272	04/01/2015	06/29/2019
CH101020	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2021
CH101020	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2021
CH101020	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2021
CH101020	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2021
CH101020	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2021
CH101020	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2021
CH101020	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2021
CH101020	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2021
CH101020	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2021
CH101020	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2021
CH101020	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	10/01/2022
CH101020	CENTERWELL PHARMACY, INC.	11010 FLORIDA CROWN DRIVE, SUITE 200		ORLANDO	FL	32824	04/01/2024
CH101020	CENTRALIA PHARMACY	417 S TOWER AVE		CENTRALIA	WA	98531	01/01/2021
CH10102Z	CITY CENTER DRUG DBA CITY CENTER DRUG IN	108 E WISHKAH ST		ABERDEEN	WA	98520	08/09/2011	09/01/2019
CH10102O	CITY CENTER DRUG DBA CITY CENTER DRUG IN	108 E WISHKAH ST		ABERDEEN	WA	98520	08/09/2011	09/01/2019
CH101020	CITY CENTER DRUG DBA CITY CENTER DRUG IN	108 E WISHKAH ST		ABERDEEN	WA	98520	07/01/2022	01/10/2023
CH10102A	CUSTOM PRESCRIPTION SHOPPE	5917 PORTAL WAY		FERNDALE	WA	98248	03/08/2010	07/15/2024
CH101020	CUSTOM PRESCRIPTION SHOPPE	5917 PORTAL WAY		FERNDALE	WA	98248	04/01/2019	07/15/2024
CH101020	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2022
CH101020	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2022
CH101020	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2021
CH101020	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	04/01/2019
CH101020	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/01/2022
CH101020	EVERGREEN PHARMACEUTICAL LLC	OMNICARE OF SEATTLE	12674 GATEWAY DR S	TUKWILA	WA	98168-3307	10/01/2022
CH101020	EVERGREEN PHARMACEUTICAL,LLC	DBA OMNICARE OF PORTLAND	11933 NE GLENN WIDING DR	PORTLAND	OR	97220-9099	04/01/2023
CH101020	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/01/2022
CH101020	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/01/2022
CH101020	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/01/2022
CH101020	FRED MEYER #665	1201 VALLEY AVENUE E.		SUMNER	WA	98390	10/01/2018
CH101020	FRED MEYER #681	ATTN: PHARMACY	2801 BICKFORD AVENUE	SNOHOMISH	WA	98290	10/01/2018	02/27/2022
CH101020	FRED MEYER #683	FRED MEYER STORES, INC.	ATTN: PHARMACY 2500 COLUMBIA HOUSE BLVD.	VANCOUVER	WA	98661	07/01/2016
CH101020	FRED MEYER #688	ATTN: PHARMACY	2902 164TH STREET SW	LYNNWOOD	WA	98087	10/01/2018
CH101020	FRED MEYER STORES	ATTN: PHARMACY	11325 SE MILL PLAIN BLVD	VANCOUVER	WA	98684-5070	07/01/2016
CH101020	FRED MEYER STORES	9925 STATE AVENUE		MARYSVILLE	WA	98270	07/01/2016
CH101020	FRED MEYER STORES	1225 W. BAKERVIEW ROAD		BELLINGHAM	WA	98226	07/01/2016
CH101020	FRED MEYER STORES	PHARMACY DEPARTMENT	7411 NE 117TH AVENUE	VANCOUVER	WA	98662	07/01/2016
CH101020	FRED MEYER STORES	555 TROSPER ROAD SW		TUMWATER	WA	98512	07/01/2016
CH101020	FRED MEYER STORES	800 LAKEWAY DRIVE		BELLINGHAM	WA	98229	07/01/2016
CH101020	FRED MEYER STORES	ATTN: PHARMACY	920 SOUTH BURLINGTON BLVD	BURLINGTON	WA	98233	07/01/2016
CH101020	FRED MEYER STORES	18805 STATE ROUTE 2		MONROE	WA	98272-1438	07/01/2016
CH101020	FRED MEYER STORES	16600 S E MCGILLIVRAY BLVD		VANCOUVER	WA	98683	07/01/2016
CH101020	FRED MEYER STORES	ATTN: PHARMACY	7250 PACIFIC AVENUE SUITE M	TACOMA	WA	98408	10/01/2018
CH101020	FRED MEYER STORES	12906 BOTHELL EVERETT HWY		EVERETT	WA	98208	10/01/2018	02/27/2022
CH101020	FRED MEYER STORES	FRED MEYER PHARMACY #424	17404 MERIDIAN E	PUYALLUP	WA	98375-6234	10/01/2018
CH101020	FRED MEYER STORES	ATTN: PHARMACY	4505 SO 19TH	TACOMA	WA	98405	10/01/2018
CH101020	FRED MEYER STORES	22303 MOUNTAIN HWY EAST		SPANAWAY	WA	98387	10/01/2018
CH101020	FRED MEYER STORES	33702 21ST AVENUE SW		FEDERAL WAY	WA	98023	01/01/2020
CH101020	FRED MEYER STORES	800 NE TENNEY ROAD		VANCOUVER	WA	98685	01/01/2020
CH101020	FRED MEYER STORES	401 NW 12TH AVENUE		BATTLE GROUND	WA	98604	01/01/2020
CH10102S	FRED MEYER STORES	9925 STATE AVENUE		MARYSVILLE	WA	98270	01/01/2024
CH10102BX	FRED MEYER STORES	PHARMACY DEPARTMENT	7411 NE 117TH AVENUE	VANCOUVER	WA	98662	01/01/2024
CH10102DS	FRED MEYER STORES	33702 21ST AVENUE SW		FEDERAL WAY	WA	98023	01/01/2024
CH10102DX	FRED MEYER STORES	555 TROSPER ROAD SW		TUMWATER	WA	98512	01/01/2024
CH10102BT	FRED MEYER STORES	18805 STATE ROUTE 2		MONROE	WA	98272-1438	01/01/2024	01/01/2025
CH10102DE	FRED MEYER STORES	ATTN: PHARMACY	4505 SO 19TH	TACOMA	WA	98405	01/01/2024
CH101020	FRED MEYER STORES #215	25250 PACIFIC HWY SOUTH		KENT	WA	98032	04/01/2023
CH101020	FRED MEYER STORES INC.	FRED MEYER PHARMACY #140	7700 HIGHWAY 99	VANCOUVER	WA	98665	07/01/2016
CH101020	FRED MEYER STORES INC.	FRED MEYER PHARMACY #28	14300 1ST AVE S	BURIEN	WA	98168	07/01/2016
CH10102AE	FRED MEYER STORES INC.	FRED MEYER PHARMACY #28	14300 1ST AVE S	BURIEN	WA	98168	01/01/2024
CH101020	FRED MEYER STORES, INC	FRED MEYER PHARMACY 186	700 SLEATER KINNEY RD SE	LACEY	WA	98503	07/01/2016
CH101020	FRED MEYER STORES, INC	ATTN: PHARMACY	801 AUBURN WAY NORTH	AUBURN	WA	98002	01/01/2020
CH10102BE	FRED MEYER STORES, INC	FRED MEYER PHARMACY 186	700 SLEATER KINNEY RD SE	LACEY	WA	98503	01/01/2024
CH10102DW	FRED MEYER STORES, INC	ATTN: PHARMACY	801 AUBURN WAY NORTH	AUBURN	WA	98002	01/01/2024	04/01/2024
CH101020	GENOA HEALTHCARE LLC	11000 LAKE CITY WAY NE STE 421		SEATTLE	WA	98125	01/01/2022
CH101020	GENOA HEALTHCARE LLC	6 E 1ST AVE		SPOKANE	WA	99202	01/01/2022	10/01/2022
CH101020	GENOA HEALTHCARE LLC	2502 E FOURTH PLAIN BLVD RM 102		VANCOUVER	WA	98661	01/01/2022
CH101020	GENOA HEALTHCARE LLC	325 W. GOWE STREET	SUITE 110	KENT	WA	98032	01/01/2022
CH101020	GENOA HEALTHCARE LLC	2722 COLBY AVENUE	STE 328A	EVERETT	WA	98201	01/01/2022
CH101020	GENOA HEALTHCARE LLC	3645 E MCLEOD RD STE P-1		BELLINGHAM	WA	98226	01/01/2022
CH101020	GENOA HEALTHCARE LLC	9330 59TH AVE SW	STE 179	LAKEWOOD	WA	98499	01/01/2022
CH101020	GENOA HEALTHCARE LLC	2704 I STREET NE		AUBURN	WA	98002	07/01/2023
CH101020	GENOA HEALTHCARE LLC	1600 EAST OLIVE STREET	BLDG D	SEATTLE	WA	98122	01/01/2024
CH101020	GENOA HEALTHCARE LLC	4508 AUBURN WAY N	STE A104	AUBURN	WA	98002	01/01/2024
CH101020	GENOA HEALTHCARE LLC	921 14TH AVE STE 201		LONGVIEW	WA	98632	01/01/2024
CH101020	GENOA HEALTHCARE LLC	737 FAWCETT AVE STE 334		TACOMA	WA	98402	01/01/2024
CH10102E	HAGGEN PHARMACY		4545 CORDATA PARKWAY	BELLINGHAM	WA	98226	11/18/2009	09/01/2019
CH10102S	HAGGEN, INC.	HAGGEN FOOD & PHARMACY #77	3711 88TH STREET NE	MARYSVILLE	WA	98270	03/08/2010	09/30/2022
CH10102BA	HAGGEN, INC.	HAGGEN FOOD & PHARMACY #69	2601 EAST DIVISION ST	MOUNT VERNON	WA	98274	03/08/2010	09/01/2019
CH101020	HARBOR DRUG INC	316 8TH ST		HOQUIAM	WA	98550	01/01/2021
CH101020	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	01/01/2017
CH101020	KMART OF WA LLC 4253		1414 E 72ND ST	TACOMA	WA	98404	10/01/2016	11/30/2016
CH101020	KMART OF WA LLC 7331	1201 NORTHWEST LOUISIANA		CHEHALIS	WA	98532	10/01/2016	02/04/2018
CH10102R	LINCOLN PHARMACY	821 SOUTH 38TH STREET		TACOMA	WA	98418	08/09/2011	09/01/2019
CH10102AE	LINCOLN PHARMACY	821 SOUTH 38TH STREET		TACOMA	WA	98418	08/19/2011	09/01/2019
CH10102AX	LINCOLN PHARMACY	821 SOUTH 38TH STREET		TACOMA	WA	98418	08/09/2011	09/01/2019
CH101020	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2019
CH101020	MARTIN'S SOUTHGATE DRUG	MARTINS SOUTHGATE DRUG	5201 CAPITOL BLVD SW	TUMWATER	WA	98501	01/01/2021	07/07/2022
CH101020	NOOKSACK VALLEY DRUG STORE	208 E MAIN ST	PO BOX 307	EVERSON	WA	98247	04/01/2015
CH10102E	NOOKSACK VALLEY DRUG STORE	208 E MAIN ST	PO BOX 307	EVERSON	WA	98247	01/01/2024
CH101020	OCEAN SHORES PHARMACY	121 E CHANCE A-LA-MER NE	P.O. BOX 1659	OCEAN SHORES	WA	98569	04/01/2015	03/21/2017
CH101020	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	07/01/2023
CH101020	OPTUM INFUSION SERVICES 404 LLC	2065 NE WILLIAMSON CT	STE B	BEND	OR	97701	07/01/2023
CH101020	OPTUM INFUSION SERVICES 501, INC.	8131 W BOSTIAN RD	STE. A345	WOODINVILLE	WA	98072	10/01/2023
CH101020	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	07/01/2023
CH101020	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	07/01/2023
CH101020	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	01/01/2022
CH101020	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/01/2023
CH101020	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
CH101020	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2022
CH101020	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	01/01/2022
CH101020	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	07/01/2023
CH101020	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/01/2023
CH101020	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	07/01/2023
CH101020	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/01/2023
CH101020	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/01/2023
CH101020	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	01/01/2022	05/27/2022
CH101020	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2022
CH101020	OREGON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17632	1555 N TOMAHAWK ISLAND DR	PORTLAND	OR	97217	01/01/2020
CH101020	OREGON CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11292	345 SW HARRISON ST	PORTLAND	OR	97201	04/01/2022
CH101020	OVERLAKE PHARMACY, LLC	4124 148TH AVE NE STE JA		REDMOND	WA	98052	04/01/2020	07/31/2023
CH101020	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2019
CH101020	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	04/01/2025
CH10102M	PREMIER LONG TERM CARE PHARMACY	1618 SOUTH LANE SUITE 204		SEATTLE	WA	98144	06/08/2012	09/01/2019
CH101020	PREMIER PHARMACY SERVICES	410 CLOVERLEAF DR		BALDWIN PARK	CA	91706	04/01/2020
CH101020	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2021
CH101020	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2926	1001 MADISON ST.	SEATTLE	WA	98104	01/01/2018
CH101020	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2819	1309 NW 23RD AVE.	PORTLAND	OR	97210	10/01/2018
CH101020	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2021
CH101020	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2021
CH101020	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2021
CH101020	QFC PHARMACY	4775 WHITMAN LANE SE		LACEY	WA	98513	10/01/2018
CH10102DU	QFC PHARMACY	4775 WHITMAN LANE SE		LACEY	WA	98513	01/01/2024
CH101020	QFC PHARMACY #829	460 E. NORTH BEND WAY		NORTH BEND	WA	98045-8270	10/01/2018	08/07/2019
CH101020	QFC PHARMACY #853	2615 BROADWAY		EVERETT	WA	98201	10/01/2018
CH101020	QFC PHARMACY #874	1510 145 PLACE SE		BELLEVUE	WA	98007	10/01/2018
CH101020	QFC PHARMACY #879	27008 92ND AVE NW		STANWOOD	WA	98292	10/01/2018
CH101020	QFC PHARMACY NO 212	3505 SE 192ND		VANCOUVER	WA	98683	10/01/2018
CH101020	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/01/2019
CH101020	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/01/2019
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1223	11919 N. JANTZEN AVENUE	PORTLAND	OR	97217	04/01/2015	08/22/2016
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1493	4011 S 164TH ST	SEATAC	WA	98188-3067	04/01/2015	03/05/2022
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1503	520 CLEVELAND AVE SE	TUMWATER	WA	98501	04/01/2015
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1508	3820 RAINER AVE S.	SEATTLE	WA	98118	04/01/2015	03/05/2022
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1611	6711 NE 63RD STREET	VANCOUVER	WA	98661	04/01/2015
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1653	2615 NE 112TH AVE	VANCOUVER	WA	98684	04/01/2015
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1965	9262 RAINIER AVE S	SEATTLE	WA	98118	04/01/2015	08/22/2016
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #3540	21401 PACIFIC HWY SOUTH	DES MOINES	WA	98198	04/01/2015	03/05/2022
CH101020	SAFEWAY INC	HAGGEN PHARMACY #3450	2601 E DIVISION ST	MOUNT VERNON	WA	98274	01/01/2017
CH101020	SAFEWAY INC	HAGGEN PHARMACY #3430	2814 MERIDIAN ST	BELLINGHAM	WA	98225	01/01/2017
CH101020	SAFEWAY INC	HAGGEN PHARMACY #3604	3711 88TH STREET NE	MARYSVILLE	WA	98270	01/01/2017	01/12/2017
CH101020	SAFEWAY INC	HAGGEN PHARMACY #3439	1401 12TH ST	BELLINGHAM	WA	98225	01/01/2017
CH101020	SAFEWAY INC	HAGGEN PHARMACY #3493	1815 MAIN ST	FERNDALE	WA	98248	01/01/2017
CH101020	SAFEWAY INC	HAGGEN PHARMACY #3460	2900 WOBURN ST	BELLINGHAM	WA	98226	01/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1294	210 WASHINGTON AVENUE SOUTH	KENT	WA	98032	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #4405	408 NE 81ST ST	VANCOUVER	WA	98665	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1952	4280 MARTIN WAY EAST	OLYMPIA	WA	98516	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1078	2930 OCEAN BEACH HWY	LONGVIEW	WA	98632	04/01/2017	03/05/2022
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0402	1450 SW ERIE STREET	OAK HARBOR	WA	98277-3104	04/01/2017	09/29/2023
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1484	4128 RUCKER AVENUE	EVERETT	WA	98203	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1449	501 N MILLER ST	WENATCHEE	WA	98801	04/01/2017	12/09/2019
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1437	1302 S 38TH ST	TACOMA	WA	98418	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #4904	821 SOUTH MAIN STREET	MYRTLE CREEK	OR	97457	04/01/2017	03/28/2018
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1472	315 EAST COLLEGE WAY	MT VERNON	WA	98273	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1495	1129 HARRISON AVE	CENTRALIA	WA	98531	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1923	9620 28TH AVE SW	SEATTLE	WA	98126	04/01/2017	03/05/2022
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1664	138 SW 148TH ST	BURIEN	WA	98166	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1464	3215 HARRISON AVE NW	OLYMPIA	WA	98502	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1223	11919 N. JANTZEN AVENUE	PORTLAND	OR	97217	04/01/2017	04/20/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0537	19651 STATE ROUTE 2	MONROE	WA	98272-1537	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1645	10223 GRAVELLY LAKE DRIVE SW	LAKEWOOD	WA	98499	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1436	1624 72ND ST E	TACOMA	WA	98404	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1485	1258 STATE AVE	MARYSVILLE	WA	98270	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1798	11501 CANYON ROAD E.	PUYALLUP	WA	98373	04/01/2017	03/05/2022
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1842	13023 NE HWY 99	VANCOUVER	WA	98686	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1687	3307 EVERGREEN WAY STE 5	WASHOUGAL	WA	98671	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1978	2637 N. PEARL STREET	TACOMA	WA	98407	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #3228	5616 176TH STREET EAST	PUYALLUP	WA	98375	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1619	1109 E YELM AVE	YELM	WA	98597	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1563	200 S. 3RD ST.	RENTON	WA	98057	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1522	20500 OLYMPIC PL NE	ARLINGTON	WA	98223	04/01/2017	03/05/2022
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1844	215 WHITESELL STREET NW.	ORTING	WA	98360	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0091	1227 15TH AVENUE	LONGVIEW	WA	98632	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1930	8071 GUIDE MERIDIAN ROAD	LYNDEN	WA	98264	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0474	1715 BROADWAY	EVERETT	WA	98201	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1173	1243 MARVIN RD NE	LACEY	WA	98516-4701	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1519	13719 SE MILL PLAIN BLVD	VANCOUVER	WA	98684	04/01/2017	11/30/2024
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0593	911 11TH STREET	ANACORTES	WA	98221	04/01/2017	03/05/2022
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0585	600 W FRANKLIN ST	SHELTON	WA	98584-3519	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0547	10105 224TH ST E	GRAHAM	WA	98338	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1977	6200 PACIFIC AVE SE	LACEY	WA	98503	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0503	11031 19TH AVE SE	EVERETT	WA	98208	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0422	611 S. MERIDIAN	PUYALLUP	WA	98371	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1287	800 NE 3RD AVE	CAMAS	WA	98607	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1704	6700 NE 162ND AVE STE 500	VANCOUVER	WA	98682	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #4313	904 WEST MAIN STREET	BATTLE GROUND	WA	98604	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #3285	1275 E SUNSET DRIVE	BELLINGHAM	WA	98226-3506	04/01/2017
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0543	4700 YELM HWY SE	LACEY	WA	98503-4986	04/01/2017
CH10102N	SAFEWAY INC	SAFEWAY PHARMACY #1103	6701 E MILL PLAIN BLVD	VANCOUVER	WA	98661	07/25/2010
CH10102N	SAFEWAY INC	SAFEWAY PHARMACY #0400	3707 MAIN ST	VANCOUVER	WA	98663	07/25/2010
CH10102Q	SAFEWAY INC	SAFEWAY PHARMACY #1464	3215 HARRISON AVE NW	OLYMPIA	WA	98502	12/10/2010
CH10102R	SAFEWAY INC	SAFEWAY PHARMACY #0329	1112 SOUTH M STREET	TACOMA	WA	98405	07/25/2010
CH10102W	SAFEWAY INC	SAFEWAY PHARMACY #2640	13308 MERIDIAN E	PUYALLUP	WA	98373	10/28/2011
CH10102AE	SAFEWAY INC	SAFEWAY PHARMACY #1664	138 SW 148TH ST	BURIEN	WA	98166	07/01/2011
CH10102O	SAFEWAY INC	SAFEWAY PHARMACY #1546	221 W HERON ST	ABERDEEN	WA	98520	08/08/2011
CH10102AG	SAFEWAY INC	SAFEWAY PHARMACY #0490	1645 140TH AVE NE	BELLEVUE	WA	98005-2320	07/01/2011	09/01/2019
CH10102AZ	SAFEWAY INC	SAFEWAY PHARMACY #0537	19651 STATE ROUTE 2	MONROE	WA	98272-1537	07/01/2011
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1103	6701 E MILL PLAIN BLVD	VANCOUVER	WA	98661	01/01/2020
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #2640	13308 MERIDIAN E	PUYALLUP	WA	98373	01/01/2020
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #1546	221 W HERON ST	ABERDEEN	WA	98520	01/01/2020
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0400	3707 MAIN ST	VANCOUVER	WA	98663	01/01/2020
CH101020	SAFEWAY INC	SAFEWAY PHARMACY #0329	1112 SOUTH M STREET	TACOMA	WA	98405	01/01/2020
CH101020	SAFEWAY INC	HAGGEN PHARMACY #3604	3711 88TH STREET NE	MARYSVILLE	WA	98270	01/01/2020
CH10102CE	SAFEWAY INC	SAFEWAY PHARMACY #1294	210 WASHINGTON AVENUE SOUTH	KENT	WA	98032	01/01/2024
CH10102EK	SAFEWAY INC	SAFEWAY PHARMACY #1485	1258 STATE AVE	MARYSVILLE	WA	98270	01/01/2024
CH10102CX	SAFEWAY INC	SAFEWAY PHARMACY #4313	904 WEST MAIN STREET	BATTLE GROUND	WA	98604	01/01/2024
CH10102CJ	SAFEWAY INC	SAFEWAY PHARMACY #0329	1112 SOUTH M STREET	TACOMA	WA	98405	01/01/2024
CH10102AG	SAFEWAY INC	SAFEWAY PHARMACY #1563	200 S. 3RD ST.	RENTON	WA	98057	01/01/2024
CH10102DG	SAFEWAY INC	HAGGEN PHARMACY #3450	2601 E DIVISION ST	MOUNT VERNON	WA	98274	01/01/2024
CH10102BG	SAFEWAY INC	SAFEWAY PHARMACY #1664	138 SW 148TH ST	BURIEN	WA	98166	01/01/2024
CH10102H	SAFEWAY INC	SAFEWAY PHARMACY #1472	315 EAST COLLEGE WAY	MT VERNON	WA	98273	01/01/2024
CH10102CF	SAFEWAY INC	SAFEWAY PHARMACY #1611	6711 NE 63RD STREET	VANCOUVER	WA	98661	01/01/2024
CH10102DL	SAFEWAY INC	SAFEWAY PHARMACY #1103	6701 E MILL PLAIN BLVD	VANCOUVER	WA	98661	01/01/2024
CH10102DQ	SAFEWAY INC	SAFEWAY PHARMACY #0400	3707 MAIN ST	VANCOUVER	WA	98663	01/01/2024
CH10102CZ	SAFEWAY INC	SAFEWAY PHARMACY #1503	520 CLEVELAND AVE SE	TUMWATER	WA	98501	01/01/2024
CH10102EG	SAFEWAY INC	SAFEWAY PHARMACY #1294	210 WASHINGTON AVENUE SOUTH	KENT	WA	98032	01/01/2024	04/01/2024
CH10102DZ	SAFEWAY INC	SAFEWAY PHARMACY #1464	3215 HARRISON AVE NW	OLYMPIA	WA	98502	01/01/2024
CH10102CA	SAFEWAY INC	SAFEWAY PHARMACY #1952	4280 MARTIN WAY EAST	OLYMPIA	WA	98516	01/01/2024
CH10102BR	SAFEWAY INC	SAFEWAY PHARMACY #1930	8071 GUIDE MERIDIAN ROAD	LYNDEN	WA	98264	01/01/2024
CH10102BS	SAFEWAY INC	SAFEWAY PHARMACY #0474	1715 BROADWAY	EVERETT	WA	98201	01/01/2024
CH10102DE	SAFEWAY INC	SAFEWAY PHARMACY #0329	1112 SOUTH M STREET	TACOMA	WA	98405	01/01/2024
CH101020	SEA-J INC	DBA ABERDEEN PHARMACY	1812 SUMNER AVE STE H	ABERDEEN	WA	98520	10/01/2023
CH101020	SEATTLEMEDS PHARMACY		1305 MADISON STREET	SEATTLE	WA	98104	04/01/2015	05/26/2017
CH101020	SHOPKO PHARMACY #2113	5500 MARTIN WAY		LACEY	WA	98506-6315	10/01/2016	01/08/2019
CH101020	SWANSON'S FOOD OF ABERDEEN	SWANSONS OWL PHARMACY	117 N. BOONE ST.	ABERDEEN	WA	98520-9852	04/01/2015	10/10/2019
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5231	10103 EVERGREEN WAY	EVERETT	WA	98204	01/01/2017	11/06/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5277	5700 100TH STREET SW STE 100	LAKEWOOD	WA	98499	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5262	1323 EAST MAIN AVENUE	PUYALLUP	WA	98372	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #6498	2800 NE 162ND AVENUE	VANCOUVER	WA	98682	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5271	7041 PACIFIC AVENUE	TACOMA	WA	98408	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5281	4776 WHITMAN LANE, S.E.	LACEY	WA	98513	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #6232	12811 MERIDIAN STREET EAST	PUYALLUP	WA	98373	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5238	220 36TH STREET	BELLINGHAM	WA	98225	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #6521	22201 MERIDIAN AVENUE E	GRAHAM	WA	98338	01/01/2017	09/05/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #6539	608 W. STANLEY STREET	GRANITE FALLS	WA	98252	01/01/2017	09/05/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5243	251 MARYSVILLE MALL	MARYSVILLE	WA	98270	01/01/2017	01/11/2024
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5235	17226 SMOKEY POINT BOULEVARD	ARLINGTON	WA	98223	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5280	8230 MARTIN WAY EAST	LACEY	WA	98516	01/01/2017	09/27/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5240	222 TELEGRAPH ROAD	BELLINGHAM	WA	98226	01/01/2017	09/20/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5286	909 EAST YELM AVENUE	YELM	WA	98597	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5236	1400 CORNWALL AVENUE	BELLINGHAM	WA	98225	01/01/2017	10/01/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5237	3227 NORTHWEST AVENUE	BELLINGHAM	WA	98225	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5190	10407 SE 256TH STREET	KENT	WA	98030	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5242	8090 GUIDE MERIDIAN ROAD.	LYNDEN	WA	98264	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5227	110 SW 148TH STREET	BURIEN	WA	98166	01/01/2017	09/27/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5239	1225 EAST SUNSET DR STE 110	BELLINGHAM	WA	98226	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5244	18906 STATE ROUTE 2	MONROE	WA	98272	01/01/2017	01/13/2022
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5245	412 EAST COLLEGE WAY	MT VERNON	WA	98273	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5279	691 SLEATER KINNEY ROAD SE	LACEY	WA	98503	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #6452	5655 3RD AVE PO BOX 2568	FERNDALE	WA	98248-2568	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5248	851 MOORE STREET	SEDRO WOOLLEY	WA	98284	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5278	305 COOPER POINT ROAD NW SUITE 103	OLYMPIA	WA	98502	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5282	301 EAST WISHKAH STREET	ABERDEEN	WA	98520	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5283	3130 SIMPSON AVENUE	HOQUIAM	WA	98550	01/01/2017
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5241	1195 BOBLETT STREET	BLAINE	WA	98230	01/01/2020
CH101020	THRIFTY PAYLESS, INC.	RITE AID #4067	3307 EVERGREEN WAY, BLDG 4	WASHOUGAL	WA	98671	01/01/2020	12/05/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5291	13511 SE THIRD WAY	VANCOUVER	WA	98684	01/01/2020	01/22/2024
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5249	205 PINE AVENUE	SNOHOMISH	WA	98290	01/01/2020
CH101020	THRIFTY PAYLESS, INC.	RITE AID #6493	9502 176TH STREET EAST	PUYALLUP	WA	98375	07/01/2022
CH101020	THRIFTY PAYLESS, INC.	RITE AID #6488	105 WASHINGTON AVENUE NORTH	KENT	WA	98032	07/01/2022	09/20/2023
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5250	26817 88TH AVENUE NW	STANWOOD	WA	98292	07/01/2022
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5220	2600 SW BARTON STREET STE H1	SEATTLE	WA	98126	07/01/2022
CH10102DJ	THRIFTY PAYLESS, INC.	RITE AID #5190	10407 SE 256TH STREET	KENT	WA	98030	01/01/2024
CH10102CL	THRIFTY PAYLESS, INC.	RITE AID #5237	3227 NORTHWEST AVENUE	BELLINGHAM	WA	98225	01/01/2024
CH10102BK	THRIFTY PAYLESS, INC.	RITE AID #5243	251 MARYSVILLE MALL	MARYSVILLE	WA	98270	01/01/2024	04/01/2024
CH10102DS	THRIFTY PAYLESS, INC.	RITE AID #5227	110 SW 148TH STREET	BURIEN	WA	98166	01/01/2024	09/27/2023
CH10102M	THRIFTY PAYLESS, INC.	RITE AID #5220	2600 SW BARTON STREET STE H1	SEATTLE	WA	98126	01/01/2024
CH10102DH	THRIFTY PAYLESS, INC.	RITE AID #5271	7041 PACIFIC AVENUE	TACOMA	WA	98408	01/01/2024
CH10102DM	THRIFTY PAYLESS, INC.	RITE AID #5277	5700 100TH STREET SW STE 100	LAKEWOOD	WA	98499	01/01/2024	04/01/2024
CH10102EJ	THRIFTY PAYLESS, INC.	RITE AID #5245	412 EAST COLLEGE WAY	MT VERNON	WA	98273	01/01/2024
CH101020	THRIFTY PAYLESS, INC.	RITE AID #5284	1200 HARRISON AVENUE	CENTRALIA	WA	98531	04/01/2024
CH101020	TIM'S PHARMACY AND GIFT SHOP	106 1ST ST S		YELM	WA	98597-7700	07/01/2016
CH101020	TRUEPILL	3121 DIABLO AVE		HAYWARD	CA	94545	04/01/2020	07/31/2023
CH101020	TULALIP PHARMACY	8825 34TH AVE NE STE A		QUIL CEDA VILLAGE	WA	98271-8085	07/01/2016
CH101020	VALU DRUGS	201 E PIONEER AVE		MONTESANO	WA	98563	01/01/2021
CH101020	VASHON PHARMACY INC	17617 VASHON HWY SW		VASHON	WA	98070	10/01/2021
CH10102EB	VASHON PHARMACY INC	17617 VASHON HWY SW		VASHON	WA	98070	01/01/2024
CH101020	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017
CH101020	WAL-MART PHARMACY 10-2037	909 EAST WISH KAH 6 HWY 12 + 101 EAST		ABERDEEN	WA	98520	04/01/2015
CH10102CT	WAL-MART PHARMACY 10-2037	909 EAST WISH KAH 6 HWY 12 + 101 EAST		ABERDEEN	WA	98520	01/01/2024
CH101020	WAL-MART PHARMACY 10-2319	1250 S.W. ERIE STREET		OAK HARBOR	WA	98277	04/01/2022	09/05/2023
CH101020	WAL-MART PHARMACY 10-2403	310 31ST AVE SE		PUYALLUP	WA	98374-1232	07/01/2016
CH10102EE	WAL-MART PHARMACY 10-2403	310 31ST AVE SE		PUYALLUP	WA	98374-1232	01/01/2024
CH101020	WAL-MART PHARMACY 10-2450	4420 MERIDIAN STREET		BELLINGHAM	WA	98226	07/01/2016
CH10102G	WAL-MART PHARMACY 10-2450	4420 MERIDIAN STREET		BELLINGHAM	WA	98226	01/01/2024
CH101020	WAL-MART PHARMACY 10-2550	221 N.E. 104TH AVENUE		VANCOUVER (EAST)	WA	98664	07/01/2016
CH10102EH	WAL-MART PHARMACY 10-2550	221 N.E. 104TH AVENUE		VANCOUVER (EAST)	WA	98664	01/01/2024
CH101020	WAL-MART PHARMACY 10-2571	1900 SO. 314TH STREET		FEDERAL WAY	WA	98003	04/01/2021
CH101020	WAL-MART PHARMACY 10-2594	1400 164TH STREET, S.W.		LYNNWOOD	WA	98087	04/01/2023
CH101020	WAL-MART PHARMACY 10-2595	8924 QUILCEDA BLVD.		TULALIP	WA	98271	01/01/2018
CH101020	WAL-MART PHARMACY 10-2596	2301 FREEWAY DRIVE		MOUNT VERNON	WA	98273	01/01/2018
CH10102BA	WAL-MART PHARMACY 10-2596	2301 FREEWAY DRIVE		MOUNT VERNON	WA	98273	01/01/2024
CH101020	WAL-MART PHARMACY 10-2947	9000 N.E. HIGHWAY 99		VANCOUVER (W)	WA	98665	07/01/2016
CH10102EA	WAL-MART PHARMACY 10-2947	9000 N.E. HIGHWAY 99		VANCOUVER (W)	WA	98665	01/01/2024
CH101020	WAL-MART PHARMACY 10-3052	7809 VANCOUVER PLAZA DR		VANCOUVER	WA	98662	07/01/2016	05/13/2019
CH101020	WAL-MART PHARMACY 10-3218	20307 MOUNTAIN HWY., EAST		SPANAWAY	WA	98387	07/01/2016
CH10102DY	WAL-MART PHARMACY 10-3218	20307 MOUNTAIN HWY., EAST		SPANAWAY	WA	98387	01/01/2024
CH10102ED	WAL-MART PHARMACY 10-3218	20307 MOUNTAIN HWY., EAST		SPANAWAY	WA	98387	01/01/2024
CH101020	WAL-MART PHARMACY 10-3525	16502 MERIDAN AVE EAST		PUYALLUP	WA	98375	01/01/2018
CH10102BU	WAL-MART PHARMACY 10-3525	16502 MERIDAN AVE EAST		PUYALLUP	WA	98375	01/01/2024
CH101020	WAL-MART PHARMACY 10-3531	1401 GALAXY DRIVE N.E.		LACEY	WA	98516-4746	01/01/2018
CH10102BC	WAL-MART PHARMACY 10-3531	1401 GALAXY DRIVE N.E.		LACEY	WA	98516-4746	01/01/2024
CH101020	WAL-MART PHARMACY 10-3537	7001 BRIDGEPORT WAY WEST		LAKEWOOD	WA	98499	07/01/2016
CH10102CG	WAL-MART PHARMACY 10-3537	7001 BRIDGEPORT WAY WEST		LAKEWOOD	WA	98499	01/01/2024
CH101020	WAL-MART PHARMACY 10-3705	17100 STATE ROUTE 507 SE		YELM	WA	98597	01/01/2018
CH101020	WAL-MART PHARMACY 10-3742	1486 DIKE ACCESS ROAD		WOODLAND	WA	98674	04/01/2021
CH101020	WAL-MART PHARMACY 10-3757	4010 172ND STREET		ARLINGTON	WA	98223	04/01/2022
CH101020	WAL-MART PHARMACY 10-3794	34520 16TH AVENUE SOUTH		FEDERAL WAY	WA	98003	01/01/2018
CH101020	WAL-MART PHARMACY 10-3801	8713 64TH ST. NE		MARYSVILLE	WA	98270	07/01/2016
CH101020	WAL-MART PHARMACY 10-3850	5900 LITTLEROCK RD. SW		TUMWATER	WA	98512	01/01/2018
CH10102CY	WAL-MART PHARMACY 10-3850	5900 LITTLEROCK RD. SW		TUMWATER	WA	98512	01/01/2024
CH101020	WAL-MART PHARMACY 10-4137	1965 S. UNION AVE		TACOMA	WA	98405	07/01/2016
CH10102DC	WAL-MART PHARMACY 10-4137	1965 S. UNION AVE		TACOMA	WA	98405	01/01/2024
CH10102BH	WAL-MART PHARMACY 10-4137	1965 S. UNION AVE		TACOMA	WA	98405	07/01/2024
CH101020	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2017
CH101020	WAL-MART PHARMACY 10-5462	430 SE 192ND AVE.		VANCOUVER (SE)	WA	98683	01/01/2018
CH101020	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017
CH101020	WALGREEN CO	DBA; WALGREENS #10995	3716 S 144TH STREET	TUKWILA	WA	98168	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 03519	4315 6TH AVE	TACOMA	WA	98406	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 03514	9505 BRIDGEPORT WAY SW	TACOMA	WA	98499	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 03518	25605 104TH AVE SE	KENT	WA	98030	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 03662	647 140TH AVENUE NE	BELLEVUE	WA	98005	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 03632	2400 S. JACKSON ST.	SEATTLE	WA	98144	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 03581	8405 PACIFIC AVENUE	TACOMA	WA	98444	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 04064	8224 STEILACOOM BLVD. SW	LAKEWOOD	WA	98498	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 04156	12405 NE 85TH ST.	KIRKLAND	WA	98033	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 03765	20725 HIGHWAY 99	LYNNWOOD	WA	98036	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 03840	14656 AMBAUM BLVD SW	BURIEN	WA	98166	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 04760	12105 PACIFIC AVENUE S.	TACOMA	WA	98444	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 04898	6330 35TH AVE. SW	SEATTLE	WA	98126	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 04627	275 RAINIER AVENUE S	RENTON	WA	98057	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 05598	6807 EVERGREEN WAY	EVERETT	WA	98203	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 05150	3737 PACIFIC AVE	TACOMA	WA	98418-7827	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 05571	1510 SW COOPER POINT RD	OLYMPIA	WA	98502	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 05911	4090 GUIDE MERIDIAN RD	BELLINGHAM	WA	98226	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 06083	4540 LACEY BLVD SE	LACEY	WA	98503	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 05697	15225 PACIFIC AVE S	TACOMA	WA	98444	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 05950	4412 RAINIER AVE S	SEATTLE	WA	98118	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 05816	9812 NE HIGHWAY 99	VANCOUVER	WA	98665	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 06103	1905 SE 164TH AVE	VANCOUVER	WA	98683	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 06102	4404 S. MERIDIAN	PUYALLUP	WA	98373-3544	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 05951	11509 CANYON ROAD EAST	PUYALLUP	WA	98373	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 06260	729 MERIDIAN AVE EAST	EDGEWOOD	WA	98371-1041	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 07131	909 17TH STREET	ANACORTES	WA	98221-2379	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 06259	9456 16TH AVE SW	SEATTLE	WA	98106-2824	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 07132	11216 4TH AVENUE WEST	EVERETT	WA	98204-4979	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 06917	8333 MARTIN WAY EAST	LACEY	WA	98516-5808	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 07390	1070 E SUNSET DRIVE	BELLINGHAM	WA	98226-3509	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 07355	3011 NE SUNSET BLVD	RENTON	WA	98056	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 07570	2205 BROADWAY	EVERETT	WA	98201-2321	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 07226	9714 E MILL PLAIN BLVD	VANCOUVER	WA	98664-3920	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 09380	6105 NE 114TH AVE	VANCOUVER	WA	98662	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 01085	3328 NE 3RD AVE	CAMAS	WA	98607-2436	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 01090	1900 NE 162ND AVE BLDG C	VANCOUVER	WA	98684-3014	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 10141	2903 NE ANDRESEN RD	VANCOUVER	WA	98661-7329	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 01089	13503 SE MILL PLAIN BLVD	VANCOUVER	WA	98684	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS #16067	2100 NE 139TH ST	VANCOUVER	WA	98686	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 01084	808 W MAIN ST STE 101	BATTLE GROUND	WA	98604	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 07782	1901 MAIN ST	FERNDALE	WA	98248-9451	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 06814	10302 SUNRISE BLVD EAST	PUYALLUP	WA	98374-8833	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 01093	2521 MAIN STREET	VANCOUVER	WA	98660-2649	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 09590	5602 PACIFIC AVE	TACOMA	WA	98408-7514	07/01/2013	04/10/2024
CH101020	WALGREEN CO.	DBA: WALGREENS # 09379	8511 NE 162ND AVE	VANCOUVER	WA	98682-3532	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS # 09423	23003 PACIFIC HWY S	DES MOINES	WA	98198-7269	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS #10304	14308 MERIDIAN E	PUYALLUP	WA	98373-5613	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS #10994	320 HARRISON ST.	SEDRO WOOLLEY	WA	98284-1035	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS #07173	22320 MERIDIAN E	GRAHAM	WA	98338	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS #11635	6708 NE 63RD ST.	VANCOUVER	WA	98661	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS #11300	623 S. BURLINGTON BLVD.	BURLINGTON	WA	98233	07/01/2013
CH101020	WALGREEN CO.	DBA: WALGREENS #12453	702 TROSPER RD. SW	TUMWATER	WA	98512-6934	07/01/2016
CH101020	WALGREEN CO.	DBA: WALGREENS #11527	2024 6TH AVE.	TACOMA	WA	98403	07/01/2016	05/03/2023
CH101020	WALGREEN CO.	DBA: WALGREENS #10553	15585 NE 24TH ST.	BELLEVUE	WA	98007-3836	07/01/2016
CH101020	WALGREEN CO.	DBA: WALGREENS #15158	404 STATE AVE	MARYSVILLE	WA	98270	07/01/2016
CH101020	WALGREEN CO.	DBA: WALGREENS # 07594	1416 HARVEY ROAD NE	AUBURN	WA	98002-3308	07/01/2016
CH101020	WALGREEN CO.	DBA: WALGREENS # 06901	28817 MILITARY ROAD SOUTH	FEDERAL WAY	WA	98003	07/01/2016
CH101020	WALGREEN CO.	DBA: WALGREENS # 04730	13110 BOTHELL EVERETT HWY.	EVERETT	WA	98208	07/01/2019
CH101020	WALGREEN CO.	DBA: WALGREENS # 07480	1701 AUBURN WAY SOUTH	AUBURN	WA	98002-6348	07/01/2019
CH101020	WALGREEN CO.	DBA: WALGREENS # 06304	27112 132ND AVE SE	KENT	WA	98042	07/01/2022
CH101020	WALGREEN CO.	DBA: WALGREENS #16095	125 SAMISH WAY	BELLINGHAM	WA	98225	01/01/2023
CH101020	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16403	1409 11TH AVE.	SEATTLE	WA	98122	01/01/2023
CH101020	WALGREEN CO.	DBA: WALGREENS #12933	718 91ST AVE. NE	LAKE STEVENS	WA	98258-2420	01/01/2023
CH101020	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	06/25/2015
CH101020	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	06/25/2015
CH101020	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	10/01/2022
CH101020	WALMART PHARMACY 10-3145	2201 GRAND BLVD.		VANCOUVER	WA	98661	07/01/2016
CH10102N	WALMART PHARMACY 10-3145	2201 GRAND BLVD.		VANCOUVER	WA	98661	01/01/2024
CH101020	WALMART PHARMACY 10-4757	5110 YELM HWY. SE		LACEY	WA	98503	01/01/2018
CH10102BZ	WALMART PHARMACY 10-4757	5110 YELM HWY. SE		LACEY	WA	98503	01/01/2024
CH101020	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH101020	WALMART PHARMACY 10-5461	14505 NE FOURTH PLAIN BLVD.		VANCOUVER	WA	98682	01/01/2018
CH10102CU	WALMART PHARMACY 10-5461	14505 NE FOURTH PLAIN BLVD.		VANCOUVER	WA	98682	01/01/2024
CH101020	WALMART PHARMACY 10-5628	19191 N KELSEY ST.		MONROE	WA	98272	04/01/2021
CH10102AZ	WALMART PHARMACY 10-5628	19191 N KELSEY ST.		MONROE	WA	98272	01/01/2024
CH101020	WALMART PHARMACY 10-5929	1201 SW 13TH AVE		BATTLE GROUND	WA	98604	01/01/2018
CH10102CV	WALMART PHARMACY 10-5929	1201 SW 13TH AVE		BATTLE GROUND	WA	98604	01/01/2024
CH101020	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10659	33520 21ST AVE. SW	FEDERAL WAY	WA	98023	01/01/2020
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16124	3310 S MERIDIAN	PUYALLUP	WA	98373	01/01/2020
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17064	2201 S COMMONS	FEDERAL WAY	WA	98003	01/01/2020
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17361	1215 N LANDING WAY	RENTON	WA	98057	01/01/2020
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10373	117 SW 160TH STREET	BURIEN	WA	98166	01/01/2020
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17219	10302 156TH ST E	PUYALLUP	WA	98374	01/01/2020
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10285	10712 SE CARR ROAD	RENTON	WA	98055	01/01/2020
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16130	5618 LAKEWOOD TOWN CENTER BLVD SW	LAKEWOOD	WA	98499	01/01/2020
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11023	9400 GRAVELLY LAKE DR SW	LAKEWOOD	WA	98499	01/01/2021
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16123	3320 S 23RD ST	TACOMA	WA	98405	01/01/2021
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16560	11400 51ST AVE NW	GIG HARBOR	WA	98332	01/01/2021
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17003	8801 NE HAZEL DELL AVE	VANCOUVER	WA	98665	01/01/2021
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS/PHARMACY # 17073	9400 192ND AVE E	BONNEY LAKE	WA	98391	01/01/2021
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16153	2925 HARRISON AVE NW	OLYMPIA	WA	98502	01/01/2022
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16167	301 STRANDER BLVD	TUKWILA	WA	98188	01/01/2022
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16694	665 SLEATER KINNEY RD SE	LACEY	WA	98503	01/01/2022
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16776	16200 SE MILL PLAIN BLVD	VANCOUVER	WA	98684	01/01/2022
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16121	405 SE EVERETT MALL WAY	EVERETT	WA	98208	04/01/2022
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17272	16818 TWIN LAKES AVE	MARYSVILLE	WA	98271	04/01/2022
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10982	2035 4TH AVE	SEATTLE	WA	98121	07/01/2022	04/04/2024
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16168	205 THREE RIVERS DR	KELSO	WA	98626	07/01/2022
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16129	30 BELLIS FAIR PKWY	BELLINGHAM	WA	98226	07/01/2022
CH101020	WASHINGTON CVS PHARMACY, L.L.C.	CVS/PHARMACY # 17754	272 116TH AVE NE	BELLEVUE	WA	98004	07/01/2022	02/19/2024
CH101020	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	04/01/2015	07/04/2018
CH101020	WESTERN PHARMACY GROUP LLC	DBA COMMUNITY MEDICAL CENTER PHARMACY	610 GATEWAY CENTER WAY SUITES A--E	SAN DIEGO	CA	92102	04/01/2019	03/15/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Bartolo, Mary VP, Deputy Director Sea Mar Community Health Centers 2067635277	Bartolo, Mary Executive Vice President Sea Mar Community Health Centers 2067635277	2/18/2025 2:32 PM
Details	Last Recertification Date	Update	Recertification	2/22/2024 4:04:38 PM	2/17/2025 7:26:46 PM	2/17/2025 7:26 PM
Details	Entity Name	Update	Group Change Request	SEA-MAR COMMUNITY HEALTH CENTER	Sea Mar Community Health Centers	1/21/2025 7:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	12/13/2024 3:33 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		2305429	12/13/2024 3:33 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WA	12/13/2024 3:33 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1437965589	12/13/2024 3:33 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	12/13/2024 3:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	9/19/2024 12:15 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1008573	9/19/2024 12:15 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WA	9/19/2024 12:15 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1356487318	9/19/2024 12:15 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	9/19/2024 12:15 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1952141582	6/11/2024 5:31 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		WA	6/11/2024 5:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2204603	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2058406	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2044533	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2059683	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2031302	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2086057	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2214235	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2012247	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2083152	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1054624	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1045030	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2045359	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2081423	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2107202	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2203608	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1356487318 (WA)		2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1881359206	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1417312828	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972606333	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1750737193	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598190597	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1861922387	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1265180129	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1356640437	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1952831471	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114113602	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1639237142	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1932587854	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1083153233	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1801372768	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033782149	2/22/2024 4:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/22/2024 4:04 PM
Details	Last Recertification Date	Update	Recertification	2/13/2023 2:21:13 PM	2/22/2024 4:04:38 PM	2/22/2024 4:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/13/2023 2:21 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2004848	2/13/2023 2:21 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	2/13/2023 2:21 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1730340753	2/13/2023 2:21 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	2/13/2023 2:21 PM
Details	Last Recertification Date	Update	Recertification	2/14/2022 4:36:37 PM	2/13/2023 2:21:13 PM	2/13/2023 2:21 PM
Addresses	Main Address	Update	Change Request	9710 State Ave Marysville, WA 98270-2232	9710 State Ave Marysville, WA 98270	8/23/2022 7:40 AM
Details	Entity Subname	Update	Change Request	SEA MAR CHC - MARYSVILLE MEDICAL & DENTAL	Sea Mar CHC - Marysville State Ave.	8/23/2022 7:40 AM
Contacts	Authorizing Official	Update	Group Change Request	Bartolo, Mary VP, Deputy Director Sea Mar Community Health Centers 2067635277	Bartolo, Mary VP, Deputy Director Sea Mar Community Health Centers 2067635277	8/12/2022 10:42 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1730340753 (WA)		2/14/2022 4:36 PM
Details	Last Recertification Date	Update	Recertification	2/3/2021 11:30:16 AM	2/14/2022 4:36:37 PM	2/14/2022 4:36 PM
Contacts	Primary Contact	Update	Group Change Request	Hoeschen, Kristina Chief Compliance Officer Sea Mar Community Health Centers 2067883203	Colberg, Luz Maria Purchasing Specialist Sea-Mar 2067883202	1/28/2022 12:52 PM
Medicaid Billing	NPI: State	Update	Recertification		WA	2/3/2021 11:30 AM
Medicaid Billing	NPI: State	Update	Recertification		WA	2/3/2021 11:30 AM
Medicaid Billing	NPI: State	Update	Recertification		WA	2/3/2021 11:30 AM
Details	Last Recertification Date	Update	Recertification	2/13/2020 9:27:13 AM	2/3/2021 11:30:16 AM	2/3/2021 11:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/17/2020 12:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1013748	6/17/2020 12:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	6/17/2020 12:53 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1356487318	6/17/2020 12:53 PM
Contacts	Primary Contact	Update	Profile Change Request	Hoeschen, Kristina Chief Compliance Officer Sea-Mar Community Health Center 2067883203	Hoeschen, Kristina Chief Compliance Officer Sea Mar Community Health Centers 2067883203	6/16/2020 8:36 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1730340753	2/13/2020 9:27 AM
Contacts	Primary Contact	Update	Recertification	Gross, Tabitha Administration and Development Manager Sea Mar Community Health Centers 2067883273	Hoeschen, Kristina Chief Compliance Officer Sea-Mar Community Health Center 2067883203	2/13/2020 9:27 AM
Details	Last Recertification Date	Update	Recertification	2/14/2019 2:46:59 PM	2/13/2020 9:27:13 AM	2/13/2020 9:27 AM
Details	Last Recertification Date	Update	Recertification	2/20/2018 4:27:27 PM	2/14/2019 2:46:59 PM	2/14/2019 2:46 PM
Contacts	Primary Contact	Update	Profile Change Request	Gross, Tabitha Development Specialist Sea Mar Community Health Centers 2067883273	Gross, Tabitha Administration and Development Manager Sea Mar Community Health Centers 2067883273	12/7/2018 1:37 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1942358908 ( )		2/20/2018 4:27 PM
Details	Last Recertification Date	Update	Recertification	2/13/2017 12:00:00 AM	2/20/2018 4:27:27 PM	2/20/2018 4:27 PM
Contacts	Authorizing Official	Update		Bartolo, Mary VP, Deputy Director 2067635277	Bartolo, Mary VP, Deputy Director Sea Mar Community Health Centers 2067635277	9/29/2017 2:42 PM
Contacts	Primary Contact	Update		Gross, Tabitha Development Specialist 2067883273	Gross, Tabitha Development Specialist Sea Mar Community Health Centers 2067883273	9/29/2017 2:41 PM
Contacts	Authorizing Official	Insert			Bartolo, Mary VP, Deputy Director 2067635277	8/9/2017 1:19 PM
Contacts	Primary Contact	Insert			Gross, Tabitha Development Specialist 2067883273	5/15/2017 2:20 PM
Addresses	Main Address	Insert			9710 State Ave Marysville, WA 98270-2232	2/13/2017 7:40 PM
Details	Last Recertification Date	Update		2/24/2016 12:00:00 AM	2/13/2017 12:00:00 AM	2/13/2017 7:40 PM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/24/2016 12:00:00 AM	3/2/2016 1:51 PM
Details	Last Recertification Date	Update		3/15/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 2:25 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/15/2014 12:00:00 AM	3/15/2014 7:59 AM
Details	Entity Name	Update		SEA MAR COMMUNITY HEALTH CENTERS	SEA-MAR COMMUNITY HEALTH CENTER	3/15/2014 7:59 AM
Addresses	Billing Address	Insert			SEA MAR COMMUNITY HEALTH CENTERS 1040 S. HENDERSON STREET SEATTLE, WA 98108	2/15/2013 1:22 PM
Addresses	Billing Address	Update		SEA MAR COMMUNITY HEALTH CENTERS 1040 S. HENDERSON STREET SEATTLE, WA 98108	SEA MAR COMMUNITY HEALTH CENTER 1040 S. HENDERSON STREET SEATTLE, WA 98108	2/15/2013 1:22 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/15/2013 1:22 PM
Details	Entity Subname	Update		MARYSVILLE MEDICAL	SEA MAR CHC - MARYSVILLE MEDICAL & DENTAL	2/15/2013 1:22 PM
Medicaid Billing	NPI: Number	Insert			1942358908	2/1/2013 8:34 PM
Medicaid Billing	NPI: Number	Insert			1578610911	2/1/2013 8:34 PM
Details	Last Recertification Date	Insert				1/22/2010 3:50 PM
Details	Grant Number	Insert			H80CS00445	1/22/2010 3:50 PM
Details	340B ID	Insert			CH10102S	1/22/2010 3:50 PM
Details	Is Authorizing Official EHB Data	Insert				1/22/2010 3:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/22/2010 3:50 PM
Details	Medicare Provider Number	Insert				1/22/2010 3:50 PM
Details	Entity Name	Insert			SEA MAR COMMUNITY HEALTH CENTERS	1/22/2010 3:50 PM
Details	Program Code	Insert			CH	1/22/2010 3:50 PM
Details	Entity Subname	Insert			MARYSVILLE MEDICAL	1/22/2010 3:50 PM
Dates	Participating Approval Date	Insert			1/22/2010 12:00:00 AM	1/22/2010 3:50 PM
Details	State	Insert			Active	1/22/2010 3:50 PM
Dates	Registration Date	Insert			7/1/2003 12:00:00 AM	1/22/2010 3:50 PM
Dates	Signed By Date	Insert				1/22/2010 3:50 PM
Dates	Start Date	Insert			7/1/2003 12:00:00 AM	1/22/2010 3:50 PM
Terminations	Termination Comments	Insert				1/22/2010 3:50 PM
Terminations	Termination Date	Insert				1/22/2010 3:50 PM
Terminations	Termination Effective Date	Insert				1/22/2010 3:50 PM
Terminations	Termination Reason	Insert				1/22/2010 3:50 PM
Details	Comments Public	Insert			2/18/08 ADDED BILL TO;	1/22/2010 3:50 PM

340B Drug Pricing Program Database