Covered Entity Details

DSH500154 MULTICARE COVINGTON MEDICAL CENTER (Active) - information as of 6/16/2025 11:23:43 PM

Main Details

Name

MULTICARE COVINGTON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500154

Medicare Provider Number

500154

Additional Details

Current Program Status

Active

Registration Date

1/10/2025

Participating Start Date

4/1/2025

Participating Approval Date

2/4/2025

Last Recertification Date

Contacts

Authorizing Official

MultiCare Health System
Timothy Wayne Lynch, Sr. VP, Chief Administrative Officer
(253) 403-2824

Primary Contact

MultiCare Health System
Cindy Wilson, Assistant Vice President - Pharmacy Compliance
(253) 403-2822

Addresses

Street Address

17700 SE 272ND STREET
COVINGTON, WA 98042

Billing Address

Multicare Covington Medical Center
PO Box: 5299
MS 1313-5-AP
Tacoma, WA 98415-0299

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

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		1326564071

Shipping Addresses

Shipping Address 1

MultiCare Covington Medical Center
17700 SE 272ND Street
Covington, WA 98042

Shipping Address 2

Safecor Health, LLC
4060 Business Park Dr.
Columbus, OH 43204

Shipping Address 3

Covington Multicare Clinic Pharmacy
17700 SE 272ND Street
Ste 100
Covington, WA 98042

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	MULTICARE DEACONESS RETAIL PHARMACY	910 W 5TH AVE, STE 270		SPOKANE	WA	99204	04/15/2025	07/01/2025			04/15/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Change Request	Multicare Covington Medical Center PO Box: 5299 MS 1313-5-AP Covington, WA 98042	Multicare Covington Medical Center PO Box: 5299 MS 1313-5-AP Tacoma, WA 98415-0299	4/14/2025 9:01 PM
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Addresses	Shipping Address	Insert	Change Request		Covington Multicare Clinic Pharmacy 17700 SE 272ND Street Ste 100 Covington, WA 98042	3/13/2025 7:32 AM
Contacts	Signed By	Insert	New Registration		Lynch, Timothy Wayne Sr. VP, Chief Administrative Officer MultiCare Health System 2534032824	2/4/2025 8:34 AM
Details	340B ID	Update	New Registration		DSH500154	2/4/2025 8:34 AM
Dates	Participating Approval Date	Update	New Registration		2/4/2025 8:34:21 AM	2/4/2025 8:34 AM
Details	State	Update	New Registration	Pending	Approved	2/4/2025 8:34 AM
Dates	Signed By Date	Update	New Registration		2/3/2025 5:30:53 PM	2/4/2025 8:34 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	2/4/2025 8:34 AM
Addresses	Main Address	Insert	New Registration		17700 SE 272ND STREET COVINGTON, WA 98042	1/10/2025 1:02 PM
Addresses	Billing Address	Insert	New Registration		Multicare Covington Medical Center PO Box: 5299 MS 1313-5-AP Covington, WA 98042	1/10/2025 1:02 PM
Addresses	Shipping Address	Insert	New Registration		MultiCare Covington Medical Center 17700 SE 272ND Street Covington, WA 98042	1/10/2025 1:02 PM
Addresses	Shipping Address	Insert	New Registration		Safecor Health, LLC 4060 Business Park Dr. Columbus, OH 43204	1/10/2025 1:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326564071	1/10/2025 1:02 PM
Medicaid Billing	NPI: State	Insert	New Registration		WA	1/10/2025 1:02 PM
Contacts	Primary Contact	Insert	New Registration		Wilson, Cindy Assistant Vice President - Pharmacy Compliance MultiCare Health System 2534032822	1/10/2025 1:02 PM
Contacts	Authorizing Official	Insert	New Registration		Lynch, Timothy Wayne Sr. VP, Chief Administrative Officer MultiCare Health System 2534032824	1/10/2025 1:02 PM
Details	Assistance Received From Date	Insert	New Registration			1/10/2025 1:02 PM
Details	Assistance Received To Date	Insert	New Registration			1/10/2025 1:02 PM
Details	Last Recertification Date	Insert	New Registration			1/10/2025 1:02 PM
Details	Grant Number	Insert	New Registration			1/10/2025 1:02 PM
Details	340B ID	Insert	New Registration			1/10/2025 1:02 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2025 1:02 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2025 1:02 PM
Details	Medicare Provider Number	Insert	New Registration		500154	1/10/2025 1:02 PM
Details	Entity Name	Insert	New Registration		MULTICARE COVINGTON MEDICAL CENTER	1/10/2025 1:02 PM
Details	NOFO Number	Insert	New Registration			1/10/2025 1:02 PM
Details	Program Code	Insert	New Registration		DSH	1/10/2025 1:02 PM
Details	Entity Subname	Insert	New Registration			1/10/2025 1:02 PM
Dates	Participating Approval Date	Insert	New Registration			1/10/2025 1:02 PM
Details	State	Insert	New Registration		Pending	1/10/2025 1:02 PM
Dates	Registration Date	Insert	New Registration		1/10/2025 1:02:28 PM	1/10/2025 1:02 PM
Dates	Signed By Date	Insert	New Registration			1/10/2025 1:02 PM
Dates	Start Date	Insert	New Registration			1/10/2025 1:02 PM
Terminations	Termination Comments	Insert	New Registration			1/10/2025 1:02 PM
Terminations	Termination Date	Insert	New Registration			1/10/2025 1:02 PM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2025 1:02 PM
Terminations	Termination Reason	Insert	New Registration			1/10/2025 1:02 PM