Covered Entity Details

DSH500088 PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER (Active) - information as of 5/5/2025 11:53:43 PM

Main Details

Name

PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500088

Medicare Provider Number

500088

Additional Details

Current Program Status

Active

Registration Date

10/3/2005

Participating Start Date

10/4/2005

Participating Approval Date

10/4/2005

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Public Hospital District No 1 of King County
Jeannine Grinnell, Chief Executive and Financial Officer
(425) 690-3310

Primary Contact

Public Hospital District No. 1 of King County
Kenneth Kenyon, VP Pharmacy Services
(425) 690-3155

Addresses

Street Address

400 S 43RD STREET
RENTON, WA 98055-5010

Billing Address

PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER
400 S 43RD STREET
P O BOX 50010
RENTON, WA 98058

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		1104969518,1649209230,1679862189

Shipping Addresses

Shipping Address 1

Valley Medical Center Pharmacy
400 South 43rd Street
Renton, WA 98055

Shipping Address 2

Prescription Pad Pharmacy - South
400 South 43rd Street
Renton, WA 98055

Shipping Address 3

Prescription Pad Pharmacy - North
3915 Talbot Road South
Renton, WA 98055

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/16/2017	01/01/2018		10/16/2017
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/16/2017	01/01/2018		10/16/2017
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/16/2017	01/01/2018		10/16/2017
Contract Detail	ACCREDO HEALTH GROUP INC	22623 68TH AVE S		KENT	WA	98032-1981	04/08/2025	07/01/2025		04/08/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/16/2017	01/01/2018	06/01/2023	06/05/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/16/2017	01/01/2018		10/16/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/16/2017	01/01/2018		10/16/2017
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/24/2022	04/01/2022		04/01/2022
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/17/2023	04/01/2023		04/01/2023
Contract Detail	AETNA SPECIALTY PHARMACY, LLC	503 SUNPORT LN		ORLANDO	FL	32809-7874	04/12/2019	07/01/2019	09/28/2022	10/11/2022
Contract Detail	ARDON HEALTH, LLC	11835 NE GLENN WIDING DR		PORTLAND	OR	97220-9057	07/12/2020	10/01/2020		10/01/2020
Contract Detail	BARTELL DRUGS #06934	12946 KENT KANGLEY ROAD		KENT	WA	98030-7940	08/06/2014	10/01/2014	11/20/2023	11/28/2023
Contract Detail	BARTELL DRUGS #06945	4700 NE 4TH ST		RENTON	WA	98059	08/06/2014	10/01/2014	03/02/2025	04/08/2025
Contract Detail	BARTELL DRUGS #06947	WILDERNESS VILLAGE	22117 SE 237TH ST	MAPLE VALLEY	WA	98038	08/06/2014	10/01/2014		02/17/2016
Contract Detail	BARTELL DRUGS #06968	17254 140TH S.E.		RENTON	WA	98058	08/06/2014	10/01/2014	03/02/2025	04/08/2025
Contract Detail	BARTELL DRUGS #19	3902 "A" STREET SE		AUBURN	WA	98002	08/06/2014	10/01/2014	09/30/2019	11/05/2019
Contract Detail	BHS EUGENE INC.	BHS PHARMACY	1455 WESTEC DR	EUGENE	OR	97402	04/29/2011	05/01/2011	04/19/2017	04/21/2017
Contract Detail	BIOPLUS SPECIALTY PHARMACY LA, LLC	2731 MANHATTAN BLVD STE B17		HARVEY	LA	70058	04/08/2025	07/01/2025		04/08/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/17/2023	10/01/2023		10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	07/17/2023	10/01/2023		10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	07/17/2023	10/01/2023		10/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/25/2024	10/01/2024		10/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/25/2024	10/01/2024		10/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY, INC	3200 LAKE EMMA RD UNIT 1000		LAKE MARY	FL	32746	07/12/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/09/2017	07/01/2017	03/01/2019	03/15/2019
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/09/2017	07/01/2017		04/09/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/09/2017	07/01/2017		04/09/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/09/2017	07/01/2017	03/01/2019	03/15/2019
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/09/2017	07/01/2017	03/01/2019	03/15/2019
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/09/2017	07/01/2017	03/01/2019	03/15/2019
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/09/2017	07/01/2017	03/01/2019	03/15/2019
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/09/2017	07/01/2017	03/01/2019	03/15/2019
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/10/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/09/2017	07/01/2017		04/09/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/21/2020	01/01/2021		01/01/2021
Contract Detail	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	07/15/2020	10/01/2020	01/01/2024	01/10/2024
Contract Detail	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	07/15/2020	10/01/2020	01/01/2024	01/10/2024
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	02/17/2021	02/17/2021		02/17/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	02/17/2021	02/17/2021		02/17/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/21/2020	01/01/2021		01/01/2021
Contract Detail	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	07/19/2015	10/01/2015	08/09/2017	08/09/2017
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	06/28/2017	07/01/2017		06/28/2017
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	07/15/2020	10/01/2020	05/03/2022	05/17/2022
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ELIXIR PHARMACY, LLC	7835 FREEDOM AVE NW		NORTH CANTON	OH	44720	10/24/2022	01/01/2023	08/26/2024	08/26/2024
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/15/2019	07/01/2019		07/01/2019
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/15/2019	07/01/2019		07/01/2019
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/15/2019	07/01/2019		07/01/2019
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/15/2019	07/01/2019		07/01/2019
Contract Detail	FRED MEYER PHARMACY	26520 MAPLE VALLEY BLACK DIAMOND RD. SE		MAPLE VALLEY	WA	98038	01/15/2016	04/01/2016		02/17/2016
Contract Detail	FRED MEYER STORES	ATTN: PHARMACY	17801 108TH AVE SE	RENTON	WA	98055	10/12/2011	10/15/2011		02/17/2016
Contract Detail	FRED MEYER STORES	10201 SE 240TH		KENT	WA	98031	10/12/2011	10/15/2011	02/17/2025	02/17/2025
Contract Detail	FRED MEYER STORES	FRED MEYER PHARMACY #459	365 RENTON CENTER WAY SW	RENTON	WA	98057-2324	10/12/2011	10/12/2011	02/17/2025	02/17/2025
Contract Detail	FRED MEYER STORES	16735 SE 272ND STREET		KENT	WA	98042	10/12/2011	10/15/2011		02/17/2016
Contract Detail	FRED MEYER STORES #215	25250 PACIFIC HWY SOUTH		KENT	WA	98032	10/12/2011	10/15/2011	02/17/2025	02/17/2025
Contract Detail	FRED MEYER STORES INC	FRED MEYER PHARMACY 41	20901 STATE ROUTE 410 E	BONNEY LAKE	WA	98391	07/12/2020	10/01/2020	06/16/2024	06/19/2024
Contract Detail	FRED MEYER STORES INC.	FRED MEYER PHARMACY #28	14300 1ST AVE S	BURIEN	WA	98168	07/12/2020	10/01/2020	06/16/2024	06/19/2024
Contract Detail	FRED MEYER STORES, INC	ATTN: PHARMACY	801 AUBURN WAY NORTH	AUBURN	WA	98002	10/12/2011	10/15/2011	06/16/2024	06/19/2024
Contract Detail	GENOA HEALTHCARE LLC	11000 LAKE CITY WAY NE STE 421		SEATTLE	WA	98125	04/18/2021	07/01/2021	10/01/2024	10/15/2024
Contract Detail	GENOA HEALTHCARE LLC	6 E 1ST AVE		SPOKANE	WA	99202	04/18/2021	07/01/2021	10/01/2024	10/15/2024
Contract Detail	GENOA HEALTHCARE LLC	4508 AUBURN WAY N	STE A104	AUBURN	WA	98002	10/15/2024	01/01/2025		01/01/2025
Contract Detail	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	07/19/2015	10/01/2015		02/17/2016
Contract Detail	LONGS DRUG STORES CALIFORNIA, LLC	D.B.A. CVS DISTRIBUTION CENTER	2400 KEYSTONE PACIFIC PKWY SUITE B	PATTERSON	CA	95363	10/07/2014	01/01/2015	08/02/2016	08/09/2016
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	10/14/2019	01/01/2020	10/31/2020	01/15/2021
Contract Detail	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	04/18/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/15/2022	04/18/2022		04/21/2022
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/15/2024	01/01/2025		01/01/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	10/14/2019	01/01/2020		01/01/2020
Contract Detail	OPTUM PHARMACY 705, LLC	11142 RENNER BLVD		LENEXA	KS	66219	07/15/2020	10/01/2020	07/01/2021	07/09/2021
Contract Detail	OPTUM PHARMACY 705, LLC	3539 BLUECUTT RD		COLUMBUS	MS	39705	07/15/2020	10/01/2020		10/01/2020
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	04/18/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	10/14/2019	01/01/2020		01/01/2020
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/14/2019	01/01/2020		01/01/2020
Contract Detail	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	04/18/2021	07/01/2021	07/01/2021	07/09/2021
Contract Detail	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	07/15/2020	10/01/2020	09/01/2022	10/11/2022
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/15/2020	10/01/2020		10/01/2020
Contract Detail	PRESCRIPTION PAD PHARMACY - SOUTH	400 S 43RD ST		RENTON	WA	98055-5714	08/18/2011	08/18/2011	05/21/2019	05/21/2019
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/16/2017	01/01/2018	10/24/2022	10/24/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/09/2017	07/01/2017		04/09/2017
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2926	1001 MADISON ST.	SEATTLE	WA	98104	10/21/2020	01/01/2021		01/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/21/2020	01/01/2021		01/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/21/2020	01/01/2021		01/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/21/2020	01/01/2021		01/01/2021
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/17/2023	10/01/2023		10/01/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1294	210 WASHINGTON AVENUE SOUTH	KENT	WA	98032	10/12/2011	10/15/2011	11/01/2017	01/03/2018
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0459	20830 108TH SE	KENT	WA	98031	10/12/2011	10/15/2011	11/01/2017	01/03/2018
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0792	17023 SE 272ND ST	COVINGTON	WA	98042-4948	04/15/2014	07/01/2014	11/01/2017	01/03/2018
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1471	26916 MAPLE VALLEY BLACK DIAMOND RD SE	MAPLE VALLEY	WA	98038-8322	04/15/2014	07/01/2014	11/01/2017	01/03/2018
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1966	13101 S.E. KENT KANGLEY RD	KENT	WA	98030-7915	04/15/2014	07/01/2014	11/01/2017	01/03/2018
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1563	200 S. 3RD ST.	RENTON	WA	98057	10/14/2016	01/01/2017	11/01/2017	01/03/2018
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1493	4011 S 164TH ST	SEATAC	WA	98188-3067	10/14/2016	01/01/2017	11/01/2017	01/03/2018
Contract Detail	THE PRESCRIPTION PAD PHARMACY - NORTH	3915 TALBOT RD S		RENTON	WA	98055-5738	06/24/2010	06/24/2010	05/21/2019	05/21/2019
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5190	10407 SE 256TH STREET	KENT	WA	98030	07/19/2015	10/01/2015		02/17/2016
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5189	20518 108TH AVE.,SE	KENT	WA	98031	07/19/2015	10/01/2015		02/17/2016
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5198	17125 SOUTHEAST 272ND STREET	COVINGTON	WA	98042	07/19/2015	10/01/2015	09/12/2023	10/17/2023
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #6488	105 WASHINGTON AVENUE NORTH	KENT	WA	98032	07/19/2015	10/01/2015	09/21/2023	10/17/2023
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #6455	17615 140TH AVENUE SE	RENTON	WA	98058	07/19/2015	10/01/2015		02/17/2016
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5203	3116 NE SUNSET BOULEVARD	RENTON	WA	98056	07/19/2015	10/01/2015		02/17/2016
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5201	601 SOUTH GRADY WAY,STE.P	RENTON	WA	98057	07/19/2015	10/01/2015	09/29/2023	10/17/2023
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5171	1231 AUBURN WAY NORTH	AUBURN	WA	98002	10/06/2016	01/01/2017	01/18/2024	01/26/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5172	1509 AUBURN WAY SOUTH	AUBURN	WA	98002	10/06/2016	01/01/2017		10/06/2016
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5185	232 ROOSEVELT AVENUE	ENUMCLAW	WA	98022	01/15/2021	04/01/2021	12/04/2023	12/06/2023
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5191	26200 PACIFIC HWY.,SOUTH	KENT	WA	98032	01/15/2021	04/01/2021	11/08/2021	01/12/2022
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5175	32015 PACIFIC HWY. SOUTH	FEDERAL WAY	WA	98003	01/15/2021	04/01/2021	12/11/2023	01/10/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5187	1065 N.W. GILMAN BLVD.	ISSAQUAH	WA	98027	01/15/2021	04/01/2021	07/31/2023	08/07/2023
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5227	110 SW 148TH STREET	BURIEN	WA	98166	01/15/2021	04/01/2021	07/31/2023	08/07/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	09/15/2014	10/01/2014		02/17/2016
Contract Detail	WAL-MART PHARMACY 10-2385	762 OUTLET COLLECTION DR SW		AUBURN	WA	98001	10/14/2016	01/01/2017		10/14/2016
Contract Detail	WAL-MART PHARMACY 10-2516	743 RAINIER AVENUE SOUTH		RENTON	WA	98057-3204	02/28/2013	04/01/2013		02/17/2016
Contract Detail	WAL-MART PHARMACY 10-5073	17432 SOUTHEAST 270TH PLACE		COVINGTON	WA	98042	02/28/2013	04/01/2013		02/17/2016
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/07/2014	01/01/2015		02/17/2016
Contract Detail	WALGREEN CO	DBA; WALGREENS #10995	3716 S 144TH STREET	TUKWILA	WA	98168	07/19/2015	10/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03518	25605 104TH AVE SE	KENT	WA	98030	04/15/2014	07/01/2014		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04627	275 RAINIER AVENUE S	RENTON	WA	98057	04/15/2014	07/01/2014		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07594	1416 HARVEY ROAD NE	AUBURN	WA	98002-3308	04/15/2014	07/01/2014		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07908	27130 172ND AVE SE	COVINGTON	WA	98042-1759	04/15/2014	07/01/2014		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06304	27112 132ND AVE SE	KENT	WA	98042	04/15/2014	07/01/2014		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07355	3011 NE SUNSET BLVD	RENTON	WA	98056	01/16/2015	04/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09423	23003 PACIFIC HWY S	DES MOINES	WA	98198-7269	01/16/2015	04/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12497	4105 NE 4TH ST.	RENTON	WA	98059-5012	01/16/2015	04/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15203	26705 MAPLE VALLEY BLACK DIAMOND RD SE	MAPLE VALLEY	WA	98038-8390	01/16/2015	04/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16403	1409 11TH AVE.	SEATTLE	WA	98122	01/16/2015	04/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06901	28817 MILITARY ROAD SOUTH	FEDERAL WAY	WA	98003	07/19/2015	10/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07480	1701 AUBURN WAY SOUTH	AUBURN	WA	98002-6348	07/19/2015	10/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07677	1502 LAKE TAPPS PKWY SE	AUBURN	WA	98092	07/19/2015	10/01/2015		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07136	1350 GARRETT STREET	ENUMCLAW	WA	98022	10/08/2015	01/01/2016		02/17/2016
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03840	14656 AMBAUM BLVD SW	BURIEN	WA	98166	07/14/2016	10/01/2016		07/14/2016
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/15/2014	07/01/2014	07/30/2015	02/17/2016
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/15/2014	07/01/2014	07/02/2019	07/10/2019
Contract Detail	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/09/2021	10/01/2021		10/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/19/2015	10/01/2015		02/17/2016
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/19/2015	10/01/2015	10/29/2021	12/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/19/2015	10/01/2015		02/17/2016
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/19/2015	10/01/2015		02/17/2016
Contract Detail	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/17/2023	04/01/2023		04/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/17/2023	01/01/2024		01/01/2024
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10285	10712 SE CARR ROAD	RENTON	WA	98055	10/07/2014	01/01/2015		01/09/2019
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16203	26301 104TH AVE SE	KENT	WA	98030	01/09/2019	04/01/2019		04/01/2019
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17361	1215 N LANDING WAY	RENTON	WA	98057	01/09/2019	04/01/2019		04/01/2019
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 16167	301 STRANDER BLVD	TUKWILA	WA	98188	01/09/2019	04/01/2019	02/07/2025	02/16/2025
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17064	2201 S COMMONS	FEDERAL WAY	WA	98003	01/09/2019	04/01/2019		04/01/2019
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10373	117 SW 160TH STREET	BURIEN	WA	98166	01/09/2019	04/01/2019		04/01/2019
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10659	33520 21ST AVE. SW	FEDERAL WAY	WA	98023	01/09/2019	04/01/2019	02/07/2025	02/16/2025
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	CVS/PHARMACY # 17073	9400 192ND AVE E	BONNEY LAKE	WA	98391	10/21/2020	01/01/2021		01/01/2021
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17219	10302 156TH ST E	PUYALLUP	WA	98374	10/21/2020	01/01/2021	02/07/2025	02/16/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH500088AA	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington Diabetes and Education	27500 168th Place SE	Covington	WA	Terminated
DSH500088AB	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Eye Clinic	3915 Talbot Road South	Renton	WA	Terminated
DSH500088AC	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Primary Care Clinics - Senior Care and Internal Medicine Clinic	4033 Talbot Road South	Renton	WA	Active
DSH500088AD	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Medication Management Clinic	4033 Talbot Road South	Renton	WA	Active
DSH500088AE	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - High Risk Genetics	4033 Talbot Road South	Renton	WA	Active
DSH500088AF	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Primary Care Clinics - Valley Women's Healthcare Clinic - Covington	16850 SE 272nd Street	Covington	WA	Active
DSH500088AG	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Urology Clinic	4033 Talbot Road South	Renton	WA	Active
DSH500088AH	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Sports Medicine	3915 Talbot Road South	Renton	WA	Active
DSH500088AJ	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Ear, Nose, and Throat Clinic, Covington	16850 SE 272nd St	Covington	WA	Active
DSH500088AK	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Dermatology, Maple Valley	26458 Maple Valley Black Diamond Rd SE	Maple Valley	WA	Active
DSH500088AL	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Cardiology, Covington	16850 SE 272nd St	Covington	WA	Active
DSH500088AM	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Medical Center - Ambulatory Infusion Center	4009 Talbot Road South	Renton	WA	Active
DSH500088AN	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Medical Center - Rehab Services	400 South 43rd Street	Renton	WA	Active
DSH500088AP	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Medical Center: - Radiation Oncology	400 South 43rd Street	Renton	WA	Active
DSH500088AQ	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics: Rheumatology - Renton	4033 Talbot Road South	Renton	WA	Active
DSH500088AR	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics: - Valley Neuroscience Institute (Adult)	400 South 43rd Street	Renton	WA	Active
DSH500088AS	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - - Allergy and Immunology Clinic, Covington	16850 SE 272nd Street, Suite 100	Covington	WA	Terminated
DSH500088AT	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Pulmonary Clinic, Covington	16850 SE 272nd Street, Suite 100	Covington	WA	Active
DSH500088AU	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - - Diabetes, Thyroid, and Endocrine Clinic	16850 SE 272nd Street, Suite 100	Covington	WA	Active
DSH500088AV	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Infectious Disease Clinic	4033 Talbot Road South	Renton	WA	Active
DSH500088AW	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	- Valley Medical Center - Infusion Center	4009 Talbot Road South	RENTON	WA	Active
DSH500088AX	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - - Child Psychiatry, Covington	27500 168th Place SE	Covington	WA	Active
DSH500088AY	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Urology Clinic, Covington	16850 SE 272nd St	Covington	WA	Active
DSH500088AZ	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC VDI - - PET CT	4033 Talbot Rd South	Renton	WA	Approved
DSH500088B	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Cascade Primary Care Clinic	3915 Talbot Rd South	Renton	WA	Active
DSH500088C	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington Primary Care Clinic	27500 168th Place SE	Covington	WA	Active
DSH500088D	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington Urgent Care	27500 168th Place SE	Covington	WA	Active
DSH500088E	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Rheumatology Clinic	16850 SE 272nd St	Covington	WA	Active
DSH500088F	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	North Benson Urgent Care	10555 SE Carr Rd	Renton	WA	Terminated
DSH500088G	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Kent Primary Care Clinic	24920 104th Ave SE	Kent	WA	Active
DSH500088H	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Family Medicine	3915 Talbot Road South	Renton	WA	Active
DSH500088J	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Nephrology Clinic	24920 104th Ave SE	Kent	WA	Active
DSH500088K	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Podiatry Clinic	24920 104th Ave SE	Kent	WA	Terminated
DSH500088L	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Diabetes Education	24920 104th Ave SE	Kent	WA	Terminated
DSH500088M	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Correctional Medicine	3915 Talbot Road South	Renton	WA	Terminated
DSH500088N	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Midwives	16850 SE 272nd St	Covington	WA	Terminated
DSH500088P	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Maternal Fetal Medicine	4033 Talbot Road South	Renton	WA	Active
DSH500088Q	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC OP Wound Service	400 South 43rd Street	Renton	WA	Active
DSH500088R	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Endoscopy Center	17820 Talbot Rd South	Renton	WA	Active
DSH500088S	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Medication Management Clinic, Covington	16850 SE 272nd St	Covington	WA	Active
DSH500088T	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington South Radiology	27500 168th Place SE	Covington	WA	Active
DSH500088U	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington Podiatry	27500 168th Place SE	Covington	WA	Active
DSH500088V	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Olympic Building Imaging	400 South 43rd Street	Renton	WA	Active
DSH500088W	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	The Breast Center	4033 Talbot Road South Suite 470	Renton	WA	Active
DSH500088X	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Maple Valley Primary Care	26458 Maple Valley Black Diamond Rd SE	Maple Valley	WA	Terminated
DSH500088Y	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Maple Valley Urgent Care	26458 Maple Valley Black Diamond Rd SE	Maple Valley	WA	Active
DSH500088Z	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	North Benson Podiatry Clinic	10555 SE Carr Road	Renton	WA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Grinnell, Jeannine Chief Financial Officer Public Hospital District No 1 of King County 4252283440-4268	Grinnell, Jeannine Chief Executive and Financial Officer Public Hospital District No 1 of King County 4256903310	8/21/2024 6:42 AM
Details	Last Recertification Date	Update	Recertification	8/25/2023 12:11:18 PM	8/20/2024 5:19:45 PM	8/20/2024 5:19 PM
Contacts	Primary Contact	Update	Profile Change Request	Kenyon, Kenneth VP Pharmacy Services Public Hospital District No. 1 of King County 4256903155-5855	Kenyon, Kenneth VP Pharmacy Services Public Hospital District No. 1 of King County 4256903155	8/1/2024 3:47 PM
Contacts	Primary Contact	Update	Profile Change Request	Kenyon, Kenneth VP Pharmacy Services Public Hospital District No. 1 of King County 4252283440-5855	Kenyon, Kenneth VP Pharmacy Services Public Hospital District No. 1 of King County 4256903155-5855	8/1/2024 3:00 PM
Details	Last Recertification Date	Update	Recertification	9/13/2022 4:58:59 PM	8/25/2023 12:11:18 PM	8/25/2023 12:11 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 10:43:28 PM	9/13/2022 4:58:59 PM	9/13/2022 4:58 PM
Contacts	Primary Contact	Update	Profile Change Request	Kenyon, Kenneth Pharmacy Director Public Hospital District No. 1 of King County 4252283440-5855	Kenyon, Kenneth VP Pharmacy Services Public Hospital District No. 1 of King County 4252283440-5855	1/19/2022 4:06 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1006267 (AK)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	023028 (AZ)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	95015509 (CO)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	OP003073963 (CT)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	098520100 (FL)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	934363385A (GA)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	542482 (HI)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	095301 (IA)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1649209230 (ID)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	916000986002 (IL)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1744972 (LA)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1649209230 (ME)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	OP1649209230 (MI)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1649209230 (MN)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	00096897 (MS)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	272688 (MT)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1474466 (ND)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	3089737 (NH)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	000B0891 (NM)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	01608300 (NY)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	0457410 (OH)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	100705530A (OK)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	207191 (OR)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1649209230 (RI)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	OP11832B (SC)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	0500088 (VT)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	80492600 (WI)		8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	110574400 (WY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (AL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (AL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (AL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (AK)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (AK)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (AK)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (AS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (AS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (AS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (AZ)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (AZ)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (AZ)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (AR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (AR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (AR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (CA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (CA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (CA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (CO)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (CO)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (CO)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (CT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (CT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (CT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (DE)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (DE)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (DE)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (DC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (DC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (DC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (FM)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (FM)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (FM)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (FL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (FL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (FL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (GA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (GA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (GA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (GU)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (GU)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (GU)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (HI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (HI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (HI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (ID)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (ID)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (ID)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (IL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (IL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (IL)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (IN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (IN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (IN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (IA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (IA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (IA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (KS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (KS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (KS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (KY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (KY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (KY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (LA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (LA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (LA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (ME)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (ME)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (ME)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MD)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MD)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MD)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MS)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MO)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MO)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MO)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (NE)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (NE)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (NE)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (NV)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (NV)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (NV)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (NH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (NH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (NH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (NJ)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (NJ)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (NJ)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (NM)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (NM)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (NM)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (NY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (NY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (NY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (NC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (NC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (NC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (ND)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (ND)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (ND)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (MP)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (MP)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (MP)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (OH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (OH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (OH)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (OK)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (OK)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (OK)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (OR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (OR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (OR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (PW)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (PW)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (PW)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (PA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (PA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (PA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (PR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (PR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (PR)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (RI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (RI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (RI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (SC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (SC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (SC)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (SD)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (SD)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (SD)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (TN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (TN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (TN)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (TX)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (TX)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (TX)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (UT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (UT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (UT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (VT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (VT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (VT)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (VI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (VI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (VI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (VA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (VA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (VA)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (WV)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (WV)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (WV)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (WI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (WI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (WI)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 (WY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 (WY)		8/30/2021 10:43 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 (WY)		8/30/2021 10:43 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 7:21:26 AM	8/30/2021 10:43:28 PM	8/30/2021 10:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1006267	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AK	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		023028	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		95015509	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CO	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		OP003073963	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		098520100	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		934363385A	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		542482	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		HI	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		095301	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IA	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		ID	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		916000986002	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1744972	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		ME	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		OP1649209230	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MI	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MN	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		00096897	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MS	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		272688	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MT	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1474466	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		ND	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3089737	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NH	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000B0891	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NM	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01608300	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0457410	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OH	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		100705530A	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OK	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		207191	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		RI	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		OP11832B	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		SC	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0500088	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VT	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		80492600	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		WI	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		110574400	9/11/2020 7:21 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		WY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1679862189 ( )		9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1104969518 ( )		9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CO	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		DE	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		DE	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		DE	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		FM	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		GU	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		HI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		KS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		LA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NE	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NV	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		ND	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		MP	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OK	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PW	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		PR	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		RI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		SD	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		SD	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		SD	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		TX	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		UT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WI	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104969518	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1649209230	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1679862189	9/11/2020 7:21 AM
Medicaid Billing	NPI: State	Insert	Recertification		WY	9/11/2020 7:21 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1649209230 ( )		9/11/2020 7:21 AM
Details	Last Recertification Date	Update	Recertification	9/10/2019 3:10:59 PM	9/11/2020 7:21:26 AM	9/11/2020 7:21 AM
Details	Last Recertification Date	Update	Recertification	9/11/2018 3:55:02 PM	9/10/2019 3:10:59 PM	9/10/2019 3:10 PM
Addresses	Shipping Address	Insert	Change Request		Valley Medical Center Pharmacy 400 South 43rd Street Renton, WA 98055	5/21/2019 12:14 PM
Addresses	Shipping Address	Insert	Change Request		Prescription Pad Pharmacy - South 400 South 43rd Street Renton, WA 98055	5/21/2019 12:14 PM
Addresses	Shipping Address	Insert	Change Request		Prescription Pad Pharmacy - North 3915 Talbot Road South Renton, WA 98055	5/21/2019 12:14 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1679862189	5/21/2019 12:14 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1104969518	5/21/2019 12:14 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 9:19:11 PM	9/11/2018 3:55:02 PM	9/11/2018 3:55 PM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	11/29/2017 9:19:11 PM	11/29/2017 9:19 PM
Contacts	Authorizing Official	Update		Grinnell, Jeannine Chief Financial Officer 4252283440-4268	Grinnell, Jeannine Chief Financial Officer Public Hospital District No 1 of King County 4252283440-4268	10/16/2017 3:03 PM
Contacts	Primary Contact	Update		Kenyon, Kenneth Pharmacy Director 4252283440-5855	Kenyon, Kenneth Pharmacy Director Public Hospital District No. 1 of King County 4252283440-5855	10/3/2017 6:25 PM
Contacts	Authorizing Official	Insert			Grinnell, Jeannine Chief Financial Officer 4252283440-4268	6/28/2017 3:55 PM
Contacts	Primary Contact	Update		RAWLINS, CODY PHARMACY BUSINESS MANAGER 4252283440-5268	Kenyon, Kenneth Pharmacy Director 4252283440-5855	6/19/2017 7:29 AM
Addresses	Main Address	Insert			400 S 43RD STREET RENTON, WA 98055-5010	6/15/2017 8:48 AM
Addresses	Billing Address	Insert			PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER 400 S 43RD STREET P O BOX 50010 RENTON, WA 98058	6/15/2017 8:48 AM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/23/2016 12:00:00 AM	8/23/2016 12:19 PM
Medicaid Billing	NPI: Number	Insert			1649209230	12/14/2015 5:40 PM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/10/2015 1:50 PM
Details	Last Recertification Date	Update		8/26/2013 12:00:00 AM	8/6/2014 12:00:00 AM	8/6/2014 3:31 PM
Details	Last Recertification Date	Update		8/26/2013 5:10:42 PM	8/26/2013 12:00:00 AM	1/6/2014 12:43 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/26/2013 5:10:42 PM	8/26/2013 5:10 PM
Contacts	Primary Contact	Insert			RAWLINS, CODY PHARMACY BUSINESS MANAGER 4252283440-5268	5/18/2012 12:10 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/18/2012 12:10 PM
Details	Last Recertification Date	Insert				7/11/2011 2:46 PM
Details	Grant Number	Insert				7/11/2011 2:46 PM
Details	340B ID	Insert			DSH500088	7/11/2011 2:46 PM
Details	Is Authorizing Official EHB Data	Insert				7/11/2011 2:46 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/11/2011 2:46 PM
Details	Medicare Provider Number	Insert			500088	7/11/2011 2:46 PM
Details	Entity Name	Insert			PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	7/11/2011 2:46 PM
Details	Program Code	Insert			DSH	7/11/2011 2:46 PM
Details	Entity Subname	Insert				7/11/2011 2:46 PM
Dates	Participating Approval Date	Insert			10/4/2005 12:00:00 AM	7/11/2011 2:46 PM
Details	State	Insert			Active	7/11/2011 2:46 PM
Dates	Registration Date	Insert			10/3/2005 12:00:00 AM	7/11/2011 2:46 PM
Dates	Signed By Date	Insert			9/27/2005 12:00:00 AM	7/11/2011 2:46 PM
Dates	Start Date	Insert			10/4/2005 12:00:00 AM	7/11/2011 2:46 PM
Terminations	Termination Comments	Insert				7/11/2011 2:46 PM
Terminations	Termination Date	Insert				7/11/2011 2:46 PM
Terminations	Termination Effective Date	Insert				7/11/2011 2:46 PM
Terminations	Termination Reason	Insert				7/11/2011 2:46 PM