340B Drug Pricing Program Database


CAH501338-00 PUBLIC HOSPITAL DISTRICT #4 KING COUNTY WASHINGTON (Active) - information as of 5/5/2025 11:52:31 PM

Main Details
PUBLIC HOSPITAL DISTRICT #4 KING COUNTY WASHINGTON
Critical Access Hospital
No
CAH501338-00
501338


Additional Details
Active
6/14/2011
7/1/2011
6/14/2011
8/20/2024

Contacts

Snoqualmie Valley Health
Jeremy Storm, CMO
(425) 414-9034

Snoqualmie Valley Hospital
Corinne Dolan, Pharmacy Manager
(425) 831-2375

Addresses

9801 Frontier Ave SE
SNOQUALMIE, WA 98065

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailBARTELL DRUGS #06917248 BENDIGO BLVD S
NORTH BENDWA98045-813401/09/201804/01/2018  01/09/2018
Contract DetailBARTELL DRUGS #0697535013 SNOQUALMIE PKWY
SNOQUALMIEWA98065-970901/09/201804/01/2018  01/09/2018
Contract DetailHEALTHY OPTIONS INCDBA POSTAL PRESCRIPTION SVCS 3500 SE 26TH AVE
PO BOX 2718 		PORTLANDOR9720210/14/201901/01/2020  01/01/2020
Contract DetailQFC PHARMACY #829460 E. NORTH BEND WAY
NORTH BENDWA98045-827004/11/201907/01/2019  07/01/2019
Contract DetailSAFEWAY INCSAFEWAY PHARMACY #1528 460 SW MT SI BLVD
NORTH BENDWA9804501/09/201804/01/2018  01/09/2018
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH501338-01ChildCAHPUBLIC HOSPITAL DISTRICT #4 KING COUNTY WASHINGTONPUBLIC HOSPITAL DISTRICT NO 4 KING - Family Medicine35020 SE KINSEY ST Suite ASNOQUALMIEWAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateAO Change RequestBENNETT, RON E PHARMACY DIRECTOR Snoqualmie Valley Hospital 4258313407Dolan, Corinne Pharmacy Manager Snoqualmie Valley Hospital 42583123754/1/2025 2:39 PM
ContactsAuthorizing OfficialUpdateAO Change RequestDenton, Karyn Luell COO Snoqualmie Valley Hospital 4258312364Storm, Jeremy CMO Snoqualmie Valley Health 42541490344/1/2025 2:39 PM
DetailsLast Recertification DateUpdateRecertification8/24/2023 9:01:13 AM8/20/2024 3:00:24 PM8/20/2024 3:00 PM
DetailsLast Recertification DateUpdateRecertification9/6/2022 1:34:09 PM8/24/2023 9:01:13 AM8/24/2023 9:01 AM
DetailsLast Recertification DateUpdateRecertification8/30/2021 4:07:02 PM9/6/2022 1:34:09 PM9/6/2022 1:34 PM
DetailsLast Recertification DateUpdateRecertification8/25/2020 9:31:06 AM8/30/2021 4:07:02 PM8/30/2021 4:07 PM
DetailsLast Recertification DateUpdateRecertification8/27/2019 12:18:55 PM8/25/2020 9:31:06 AM8/25/2020 9:31 AM
DetailsLast Recertification DateUpdateRecertification8/28/2018 1:38:34 PM8/27/2019 12:18:55 PM8/27/2019 12:18 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestDenton, Karyn Luell CEO Snoqualmie Valley Hospital 4258312364Denton, Karyn Luell COO Snoqualmie Valley Hospital 42583123648/26/2019 11:11 AM
ContactsAuthorizing OfficialUpdateChange RequestDaniel, Stephen Roy CFO Snoqualmie Valley Hospital 4258313429Denton, Karyn Luell CEO Snoqualmie Valley Hospital 42583123647/22/2019 8:53 AM
ContactsAuthorizing OfficialUpdateChange RequestPARKER, THOMAS S. CEO Snoqualmie Valley Hospital` 4258312364Daniel, Stephen Roy CFO Snoqualmie Valley Hospital 42583134291/16/2019 7:51 AM
Medicaid BillingNPI: NumberDeleteRecertification1700097615 ( ) 8/28/2018 1:38 PM
DetailsLast Recertification DateUpdateRecertification12/5/2017 3:47:44 PM8/28/2018 1:38:34 PM8/28/2018 1:38 PM
DetailsLast Recertification DateUpdateRecertification9/1/2016 12:00:00 AM12/5/2017 3:47:44 PM12/5/2017 3:47 PM
ContactsAuthorizing OfficialUpdate PARKER, THOMAS S. CEO 4258312364PARKER, THOMAS S. CEO Snoqualmie Valley Hospital` 425831236412/5/2017 3:41 PM
ContactsPrimary ContactUpdate BENNETT, RON PHARMACY DIRECTOR 4258313407BENNETT, RON E PHARMACY DIRECTOR Snoqualmie Valley Hospital 42583134079/29/2017 5:05 PM
AddressesMain AddressInsert   9801 Frontier Ave SE SNOQUALMIE, WA 980659/1/2016 2:19 PM
ContactsPrimary ContactInsert  BENNETT, RON PHARMACY DIRECTOR 42583134079/1/2016 2:19 PM
ContactsAuthorizing OfficialInsert  PARKER, THOMAS S. CEO 42583123649/1/2016 2:19 PM
DetailsLast Recertification DateUpdate 8/11/2015 12:00:00 AM9/1/2016 12:00:00 AM9/1/2016 2:19 PM
DetailsLast Recertification DateUpdate 8/13/2014 12:00:00 AM8/11/2015 12:00:00 AM8/11/2015 7:43 AM
DetailsLast Recertification DateUpdate 9/5/2013 6:10:21 PM8/13/2014 12:00:00 AM8/13/2014 2:05 PM
DetailsLast Recertification DateUpdate  9/5/2013 6:10:21 PM9/5/2013 6:10 PM
DetailsLast Recertification DateInsert   6/14/2011 3:42 PM
DetailsGrant NumberInsert   6/14/2011 3:42 PM
Details340B IDInsert  CAH501338-006/14/2011 3:42 PM
DetailsIs Authorizing Official EHB DataInsert   6/14/2011 3:42 PM
DatesLast Date That 340B Drugs PurchasedInsert   6/14/2011 3:42 PM
DetailsMedicare Provider NumberInsert  5013386/14/2011 3:42 PM
DetailsEntity NameInsert  PUBLIC HOSPITAL DISTRICT #4 KING COUNTY WASHINGTON6/14/2011 3:42 PM
DetailsProgram CodeInsert  CAH6/14/2011 3:42 PM
DetailsEntity SubnameInsert   6/14/2011 3:42 PM
DatesParticipating Approval DateInsert  6/14/2011 12:00:00 AM6/14/2011 3:42 PM
DetailsStateInsert  Active6/14/2011 3:42 PM
DatesRegistration DateInsert  6/14/2011 12:00:00 AM6/14/2011 3:42 PM
DatesSigned By DateInsert  3/22/2011 12:00:00 AM6/14/2011 3:42 PM
DatesStart DateInsert  7/1/2011 12:00:00 AM6/14/2011 3:42 PM
TerminationsTermination CommentsInsert   6/14/2011 3:42 PM
TerminationsTermination DateInsert   6/14/2011 3:42 PM
TerminationsTermination Effective DateInsert   6/14/2011 3:42 PM
TerminationsTermination ReasonInsert   6/14/2011 3:42 PM
Medicaid BillingNPI: NumberInsert  17000976156/14/2011 1:19 PM