Covered Entity Details

DSH500015 MULTICARE AUBURN MEDICAL CENTER (Active) - information as of 6/24/2025 3:00:27 AM

Main Details

Name

MULTICARE AUBURN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500015

Medicare Provider Number

500015

Additional Details

Current Program Status

Active

Registration Date

10/9/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/12/2014

Last Recertification Date

8/18/2024

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

202 NORTH DIVISION STREET
AUBURN, WA 98001

Billing Address

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

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

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

State	Medicaid Number	NPI Number
WA	2022467	1255327201

Shipping Addresses

Shipping Address 1

Multicare Auburn Medical Center Pharmacy
202 North Division Street
Auburn, WA 98001

Shipping Address 2

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

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #3106	11012 CANYON RD E	PUYALLUP	WA	98373	04/15/2020	07/01/2020	05/31/2022	06/02/2022
Contract Detail	ALBERTSON'S LLC	SAV-ON PHARMACY #493	104 MILLITARY ROAD SOUTH	TACOMA	WA	98444	04/16/2020	07/01/2020	05/31/2022	06/02/2022
Contract Detail	ALBERTSON'S LLC	SAFEWAY PHARMACY #3411	8611 STEILACOOM BLVD. SW	LAKEWOOD	WA	98498	04/16/2020	07/01/2020	05/31/2022	06/02/2022
Contract Detail	ARDON HEALTH, LLC	11835 NE GLENN WIDING DR		PORTLAND	OR	97220-9057	10/07/2020	01/01/2021		01/01/2021
Contract Detail	BARTELL DRUGS #06932	27055 PACIFIC HIGHWAY SOUTH		DES MOINES	WA	98198	04/18/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	BARTELL DRUGS #06934	12946 KENT KANGLEY ROAD		KENT	WA	98030-7940	04/18/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	BARTELL DRUGS #06954	3601-6TH AVENUE		TACOMA	WA	98406	04/18/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	BARTELL DRUGS #06957	THE BARTELL DRUG COMPANY	1850 S MILDRED ST	TACOMA	WA	98465	04/18/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/17/2020	07/01/2020	06/30/2025	05/28/2025
Contract Detail	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	01/11/2021	04/01/2021	03/15/2024	03/15/2024
Contract Detail	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	01/11/2021	04/01/2021	03/15/2024	03/15/2024
Contract Detail	COSTLESS SENIOR SERVICES, INC	14216 92ND AVE NW STE B		GIG HARBOR	WA	98329	01/16/2024	04/01/2024		04/01/2024
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	01/05/2017	04/01/2017	04/01/2017	01/17/2019
Contract Detail	DIPLOMAT SPECIALTY PHARMACY OF SOUTHERN	DIPLOMAT SPECIALTY PHARMACY	1809 EXCISE AVENUE SUITE 204-208	ONTARIO	CA	91761	01/05/2017	04/01/2017	04/01/2017	01/17/2019
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/15/2020	07/01/2020		07/01/2020
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/16/2020	07/01/2020		07/01/2020
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/16/2020	07/01/2020		07/01/2020
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/16/2020	07/01/2020		07/01/2020
Contract Detail	FRED MEYER #665	1201 VALLEY AVENUE E.		SUMNER	WA	98390	04/07/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	FRED MEYER PHARMACY	26520 MAPLE VALLEY BLACK DIAMOND RD. SE		MAPLE VALLEY	WA	98038	04/09/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	FRED MEYER PHARMACY #424	17404 MERIDIAN E	PUYALLUP	WA	98375-6234	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	6901 SOUTH 19TH STREET		TACOMA	WA	98466	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	ATTN: PHARMACY	4505 SO 19TH	TACOMA	WA	98405	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	1100 NORTH MERIDIAN		PUYALLUP	WA	98371	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	6305 BRIDGEPORT WAY WEST		UNIVERSITY PLACE	WA	98467	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	33702 21ST AVENUE SW		FEDERAL WAY	WA	98023	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	16735 SE 272ND STREET		KENT	WA	98042	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	ATTN: PHARMACY	7250 PACIFIC AVENUE SUITE M	TACOMA	WA	98408	04/09/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES	22303 MOUNTAIN HWY EAST		SPANAWAY	WA	98387	04/09/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES #215	25250 PACIFIC HWY SOUTH		KENT	WA	98032	04/09/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES INC	FRED MEYER PHARMACY 41	20901 STATE ROUTE 410 E	BONNEY LAKE	WA	98391	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	FRED MEYER STORES, INC	ATTN: PHARMACY	801 AUBURN WAY NORTH	AUBURN	WA	98002	04/07/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	HEALTHY OPTIONS INC	DBA POSTAL PRESCRIPTION SVCS	3500 SE 26TH AVE PO BOX 2718	PORTLAND	OR	97202	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	LINCOLN PHARMACY	821 SOUTH 38TH STREET		TACOMA	WA	98418	01/16/2024	04/01/2024		04/01/2024
Contract Detail	MULTICARE BONNEY LAKE PHARMACY	10004 204TH AVE E, STE 1100		BONNEY LAKE	WA	98391	04/17/2020	04/21/2020		04/21/2020
Contract Detail	MULTICARE DEACONESS RETAIL PHARMACY	910 W 5TH AVE, STE 270		SPOKANE	WA	99204	04/15/2025	07/01/2025		04/15/2025
Contract Detail	MULTICARE HOME INFUSION	315 MARTIN LUTHER KING JR WAY	PO BOX 5299	TACOMA	WA	98415-0299	07/13/2022	10/01/2022	09/30/2024	09/30/2024
Contract Detail	MULTICARE MEDICAL CENTER ED PHARMACY	315 Martin Luther King Jr Way		Tacoma	WA	98405	04/07/2020	04/15/2020		04/15/2020
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	01/10/2021	04/01/2021	04/17/2025	04/17/2025
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	04/12/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/12/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	04/12/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/12/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	04/12/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	PURDY COST LESS PRESCRIPTIONS	PHARMACY	14218 92ND AVE NW	GIG HARBOR	WA	98329-8710	01/16/2024	04/01/2024		04/01/2024
Contract Detail	QFC PHARMACY	1009 MONROE ST		ENUMCLAW	WA	98022	04/07/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1294	210 WASHINGTON AVENUE SOUTH	KENT	WA	98032	04/09/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0329	1112 SOUTH M STREET	TACOMA	WA	98405	04/09/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #2640	13308 MERIDIAN E	PUYALLUP	WA	98373	04/09/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #3545	900 MERIDIAN E STE 12	MILTON	WA	98354-7002	04/12/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1555	1207 S 320TH ST	FEDERAL WAY	WA	98003-5379	04/12/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #3228	5616 176TH STREET EAST	PUYALLUP	WA	98375	04/12/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0531	101 AUBURN WAY SOUTH	AUBURN	WA	98002	04/12/2020	07/01/2020	08/11/2024	08/11/2024
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1844	215 WHITESELL STREET NW.	ORTING	WA	98360	04/12/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #3424	2411 N PROCTOR ST	TACOMA	WA	98406	04/12/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1645	10223 GRAVELLY LAKE DRIVE SW	LAKEWOOD	WA	98499	04/14/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0792	17023 SE 272ND ST	COVINGTON	WA	98042-4948	04/14/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0547	10105 224TH ST E	GRAHAM	WA	98338	04/14/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1246	6201 6TH AVENUE	TACOMA	WA	98406	04/14/2020	07/01/2020	10/01/2021	10/31/2021
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0494	152 ROOSEVELT AVE	ENUMCLAW	WA	98022	04/14/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1436	1624 72ND ST E	TACOMA	WA	98404	04/14/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1978	2637 N. PEARL STREET	TACOMA	WA	98407	04/14/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0422	611 S. MERIDIAN	PUYALLUP	WA	98371	04/14/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #0544	21301 STATE ROUTE 410 E	BONNEY LAKE	WA	98391	04/15/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1594	707 S 56TH ST	TACOMA	WA	98408	04/15/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #3321	4831 POINT FOSDICK DR NW	GIG HARBOR	WA	98335-1732	04/15/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1471	26916 MAPLE VALLEY BLACK DIAMOND RD SE	MAPLE VALLEY	WA	98038-8322	04/15/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	HAGGEN PHARMACY #3438	1406 LAKE TAPPS PKWY SE	AUBURN	WA	98092	04/15/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1437	1302 S 38TH ST	TACOMA	WA	98418	04/15/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1798	11501 CANYON ROAD E.	PUYALLUP	WA	98373	04/15/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SAFEWAY INC	SAFEWAY PHARMACY #1966	13101 S.E. KENT KANGLEY RD	KENT	WA	98030-7915	04/15/2020	07/01/2020	04/14/2023	04/14/2023
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	01/10/2021	04/01/2021	04/17/2025	04/17/2025
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	01/10/2021	04/01/2021	04/17/2025	04/17/2025
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5171	1231 AUBURN WAY NORTH	AUBURN	WA	98002	04/16/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5172	1509 AUBURN WAY SOUTH	AUBURN	WA	98002	04/17/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5190	10407 SE 256TH STREET	KENT	WA	98030	04/17/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5256	900 EAST MERIDIAN SUITE 23	MILTON	WA	98354	04/17/2020	07/01/2020	09/30/2024	09/30/2024
Contract Detail	THRIFTY PAYLESS, INC.	RITE AID #5198	17125 SOUTHEAST 272ND STREET	COVINGTON	WA	98042	04/17/2020	07/01/2020	09/11/2023	09/19/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/15/2019	07/01/2019	09/01/2024	09/01/2024
Contract Detail	WAL-MART PHARMACY 10-2385	762 OUTLET COLLECTION DR SW		AUBURN	WA	98001	04/15/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	WAL-MART PHARMACY 10-2385	762 OUTLET COLLECTION DR SW		AUBURN	WA	98001	04/06/2023	07/01/2023	09/01/2024	09/01/2024
Contract Detail	WAL-MART PHARMACY 10-2403	310 31ST AVE SE		PUYALLUP	WA	98374-1232	04/15/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	WAL-MART PHARMACY 10-3525	16502 MERIDAN AVE EAST		PUYALLUP	WA	98375	04/15/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	WAL-MART PHARMACY 10-5041	19205 SR 410 EAST		BONNEY LAKE	WA	98391	04/15/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	WAL-MART PHARMACY 10-5041	19205 SR 410 EAST		BONNEY LAKE	WA	98391	04/06/2023	07/01/2023	09/01/2024	09/01/2024
Contract Detail	WAL-MART PHARMACY 10-5073	17432 SOUTHEAST 270TH PLACE		COVINGTON	WA	98042	04/15/2019	07/01/2019	07/16/2020	07/19/2020
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/15/2019	07/01/2019	09/01/2024	09/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07136	1350 GARRETT STREET	ENUMCLAW	WA	98022	04/17/2020	07/01/2020	06/15/2025	06/15/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07677	1502 LAKE TAPPS PKWY SE	AUBURN	WA	98092	04/17/2020	07/01/2020	06/15/2025	06/15/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07594	1416 HARVEY ROAD NE	AUBURN	WA	98002-3308	04/17/2020	07/01/2020	06/15/2025	06/15/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07480	1701 AUBURN WAY SOUTH	AUBURN	WA	98002-6348	04/17/2020	07/01/2020	06/15/2025	06/15/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06901	28817 MILITARY ROAD SOUTH	FEDERAL WAY	WA	98003	04/17/2020	07/01/2020	06/15/2025	06/15/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07908	27130 172ND AVE SE	COVINGTON	WA	98042-1759	04/17/2020	07/01/2020	06/15/2025	06/15/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06260	729 MERIDIAN AVE EAST	EDGEWOOD	WA	98371-1041	04/17/2020	07/01/2020	06/15/2025	06/15/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06304	27112 132ND AVE SE	KENT	WA	98042	04/17/2020	07/01/2020	06/15/2025	06/15/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/17/2020	07/01/2020	09/28/2023	09/29/2023
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/06/2023	07/01/2023	09/01/2024	09/01/2024
Contract Detail	WASHINGTON CVS PHARMACY, L.L.C.	CVS PHARMACY # 17064	2201 S COMMONS	FEDERAL WAY	WA	98003	04/17/2020	07/01/2020	06/30/2025	05/28/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH500015A	Child	DSH	MULTICARE AUBURN MEDICAL CENTER	AMC PHARMACEUTICAL RESOURCE CLINIC - AMC PHARMACEUTICAL RESOURCE CLINIC	202 North Division St Suite #401	AUBURN	WA	Active
DSH500015B	Child	DSH	MULTICARE AUBURN MEDICAL CENTER	AMC SLEEP CENTER - AMC SLEEP CENTER	121 North Division, Suite 300	AUBURN	WA	Active
DSH500015C	Child	DSH	MULTICARE AUBURN MEDICAL CENTER	AMC WOUND HEALING & HYPERBARIC SVCS - AMC WOUND HEALING & HYPERBARIC SVCS	1 East Main Street #160	AUBURN	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/6/2023 1:40:45 PM	8/18/2024 7:37:29 PM	8/18/2024 7:37 PM
Details	Last Recertification Date	Update	Recertification	9/19/2022 10:34:47 AM	9/6/2023 1:40:45 PM	9/6/2023 1:40 PM
Contacts	Authorizing Official	Update	AO Change Request	Chang, Florence President MULTICARE HEALTH SYSTEM 2534037355	Lynch, Timothy Wayne Sr. VP, Chief Administrative Officer MultiCare Health System 2534032824	11/7/2022 8:38 AM
Details	Last Recertification Date	Update	Recertification	9/8/2021 3:24:27 PM	9/19/2022 10:34:47 AM	9/19/2022 10:34 AM
Addresses	Shipping Address	Insert	Change Request		Safecor Health, LLC 4060 Business Park Dr. Columbus, OH 43204	6/21/2022 7:39 AM
Contacts	Authorizing Official	Update	Profile Change Request	Chang, Florence Executive Vice President MULTICARE HEALTH SYSTEM 2534037355	Chang, Florence President MULTICARE HEALTH SYSTEM 2534037355	4/18/2022 7:16 AM
Contacts	Signed By	Update	Profile Change Request	Chang, Florence Executive Vice President MULTICARE HEALTH SYSTEM 2534037355	Chang, Florence President MULTICARE HEALTH SYSTEM 2534037355	4/18/2022 7:16 AM
Contacts	Primary Contact	Update	Profile Change Request	Wilson, Cindy Executive Director Pharmacy Compliance MultiCare Health System 2534032822	Wilson, Cindy Assistant Vice President - Pharmacy Compliance MultiCare Health System 2534032822	4/15/2022 12:38 PM
Contacts	Primary Contact	Update	Profile Change Request	Wilson, Cindy Director Pharmacy Compliance MultiCare Health System 2534032822	Wilson, Cindy Executive Director Pharmacy Compliance MultiCare Health System 2534032822	12/1/2021 11:55 AM
Contacts	Primary Contact	Update	Group Change Request	Campanella, Maria Director 340B Program MultiCare Health System 2534038314	Wilson, Cindy Director Pharmacy Compliance MultiCare Health System 2534032822	11/1/2021 9:36 AM
Contacts	Primary Contact	Update	Recertification	Wilson, Cindy Director Pharmacy Compliance MultiCare Health System 2534032822	Campanella, Maria Director 340B Program MultiCare Health System 2534038314	9/8/2021 3:24 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 1:51:29 AM	9/8/2021 3:24:27 PM	9/8/2021 3:24 PM
Contacts	Primary Contact	Update	Change Request	Scheer, LeeAnn Director of Pharmacy Supply Chain and 340B Multicare Health System 5127898341	Wilson, Cindy Director Pharmacy Compliance MultiCare Health System 2534032822	7/7/2021 8:06 AM
Addresses	Billing Address	Update	Change Request	Multicare Auburn Medical Center 737 South Fawcett MS 737-4-AP Tacoma, WA 98415-0299	Multicare Auburn Medical Center PO Box: 5299 MS 1313-5-AP Tacoma, WA 98415-0299	5/16/2021 10:19 PM
Contacts	Primary Contact	Update	Profile Change Request	Scheer, LeeAnn Director of Pharmacy Supply Chain and 340B Multicare Health System 2534032934	Scheer, LeeAnn Director of Pharmacy Supply Chain and 340B Multicare Health System 5127898341	12/4/2020 7:15 PM
Medicaid Billing	NPI: State	Update	Recertification		WA	9/9/2020 1:51 AM
Details	Last Recertification Date	Update	Recertification	9/18/2019 6:56:01 AM	9/9/2020 1:51:29 AM	9/9/2020 1:51 AM
Contacts	Primary Contact	Update	Change Request	Johnson, Jae Pharmacy 340B Analyst Multicare Health Systems 2534035541	Scheer, LeeAnn Director of Pharmacy Supply Chain and 340B Multicare Health System 2534032934	3/2/2020 8:18 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1770579534 ( )		1/13/2020 12:26 AM
Contacts	Primary Contact	Update	Change Request	Aflatooni, Vafa Director Pharmacy Supply Chain and 340B MultiCare Health System 2534032082	Johnson, Jae Pharmacy 340B Analyst Multicare Health Systems 2534035541	11/22/2019 9:40 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	500015	2022467	11/8/2019 12:19 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1639582190 ( )		11/8/2019 12:19 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 1:43:19 PM	9/18/2019 6:56:01 AM	9/18/2019 6:56 AM
Contacts	Primary Contact	Update	Profile Change Request	Aflatooni, Vafa Pharmacy Manager MultiCare Health System 2534032082	Aflatooni, Vafa Director Pharmacy Supply Chain and 340B MultiCare Health System 2534032082	5/15/2019 4:37 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1639582190	12/12/2018 12:32 AM
Details	Last Recertification Date	Update	Recertification	11/5/2017 8:11:09 PM	8/27/2018 1:43:19 PM	8/27/2018 1:43 PM
Contacts	Primary Contact	Update	Change Request	Rowe, Tom Director, Phamacy Acute Care MultiCare Health System 2534031629	Aflatooni, Vafa Pharmacy Manager MultiCare Health System 2534032082	1/18/2018 1:17 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/24/2017 7:14 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500015	11/24/2017 7:14 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	11/24/2017 7:14 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1255327201	11/24/2017 7:14 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1770579534	11/24/2017 7:14 PM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/5/2017 8:11:09 PM	11/5/2017 8:11 PM
Contacts	Primary Contact	Update	Profile Change Request	Rowe, Tom Pharmacy Clinical Manager MultiCare Health System 2534031629	Rowe, Tom Director, Phamacy Acute Care MultiCare Health System 2534031629	10/18/2017 8:53 PM
Contacts	Primary Contact	Update		Rowe, Tom Pharmacy Clinical Manager 2534031629	Rowe, Tom Pharmacy Clinical Manager MultiCare Health System 2534031629	10/18/2017 8:49 PM
Contacts	Authorizing Official	Update		Chang, Florence Executive Vice President 2534037355	Chang, Florence Executive Vice President MULTICARE HEALTH SYSTEM 2534037355	10/9/2017 5:21 PM
Contacts	Signed By	Update		Chang, Florence Executive Vice President 2534037355	Chang, Florence Executive Vice President MULTICARE HEALTH SYSTEM 2534037355	10/9/2017 5:21 PM
Contacts	Authorizing Official	Insert			Chang, Florence Executive Vice President 2534037355	2/15/2017 11:03 AM
Contacts	Signed By	Insert			Chang, Florence Executive Vice President 2534037355	2/15/2017 11:03 AM
Contacts	Primary Contact	Insert			Rowe, Tom Pharmacy Clinical Manager 2534031629	9/7/2016 5:43 PM
Addresses	Main Address	Insert			202 NORTH DIVISION STREET AUBURN, WA 98001	8/29/2016 12:42 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 12:42 PM
Details	Last Recertification Date	Update			8/19/2015 12:00:00 AM	8/19/2015 1:49 PM
Addresses	Billing Address	Insert			Multicare Auburn Medical Center 737 South Fawcett MS 737-4-AP Tacoma, WA 98415-0299	12/12/2014 9:31 AM
Addresses	Shipping Address	Insert			Multicare Auburn Medical Center Pharmacy 202 North Division Street Auburn, WA 98001	12/12/2014 9:31 AM
Details	Entity Subname	Update		MULTICARE AUBURN MEDICAL CENTER		12/12/2014 9:31 AM
Dates	Participating Approval Date	Update			12/12/2014 12:00:00 AM	12/12/2014 9:31 AM
Details	State	Update		Pending	Active	12/12/2014 9:31 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/12/2014 9:31 AM
Details	340B ID	Update		ONLINE_REG_46967	DSH500015	11/3/2014 7:47 AM
Details	Entity Subname	Update			MULTICARE AUBURN MEDICAL CENTER	11/3/2014 7:47 AM
Details	340B ID	Update			ONLINE_REG_46967	10/9/2014 7:15 PM
Details	Last Recertification Date	Insert				10/9/2014 7:15 PM
Details	Grant Number	Insert				10/9/2014 7:15 PM
Details	340B ID	Insert				10/9/2014 7:15 PM
Details	Is Authorizing Official EHB Data	Insert				10/9/2014 7:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/9/2014 7:15 PM
Details	Medicare Provider Number	Insert			500015	10/9/2014 7:15 PM
Details	Entity Name	Insert			MULTICARE AUBURN MEDICAL CENTER	10/9/2014 7:15 PM
Details	Program Code	Insert			DSH	10/9/2014 7:15 PM
Details	Entity Subname	Insert				10/9/2014 7:15 PM
Dates	Participating Approval Date	Insert				10/9/2014 7:15 PM
Details	State	Insert			Pending	10/9/2014 7:15 PM
Dates	Registration Date	Insert			10/9/2014 12:00:00 AM	10/9/2014 7:15 PM
Dates	Signed By Date	Insert			10/9/2014 12:00:00 AM	10/9/2014 7:15 PM
Dates	Start Date	Insert				10/9/2014 7:15 PM
Terminations	Termination Comments	Insert				10/9/2014 7:15 PM
Terminations	Termination Date	Insert				10/9/2014 7:15 PM
Terminations	Termination Effective Date	Insert				10/9/2014 7:15 PM
Terminations	Termination Reason	Insert				10/9/2014 7:15 PM