Covered Entity Details

DSH500129AQ TACOMA GENERAL/ALLENMORE HOSPITAL (Active) - information as of 4/28/2025 12:44:19 AM

Main Details

Name

TACOMA GENERAL/ALLENMORE HOSPITAL

Subdivision Name

MULTICARE HEALTH SYSTEM - GH HSD MRI

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500129AQ

Medicare Provider Number

500129

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/12/2017

Participating Start Date

1/1/2018

Participating Approval Date

11/8/2017

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

4545 Point Fosdick Drive NW
Gig Harbor, WA 98335

Billing Address

MULTICARE HEALTH SYSTEM
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	1043908	1366556227,1841741311

Shipping Addresses

Shipping Address 1

MULTICARE HEALTH SYSTEM
315 MARTIN LUTHER KING JR. WAY
TACOMA, WA 98405

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH500129AA	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	AHC AMBULATORY INFUSION SUITE	3124 S. 19th Street	Tacoma	WA	Active
DSH500129AC	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MultiCare Obgyn Associate II Clinic	521 Martin Luther King Jr Way	Tacoma	WA	Terminated
DSH500129AE	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	CT Scan Allenmore C	3124 South 19th St Suite 100	Tacoma	WA	Active
DSH500129AF	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MRI Allenmore C	3124 South 19th St Suite 100	Tacoma	WA	Active
DSH500129AG	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Imaging Services Allenmore C	3124 South 19th St Suite 100	Tacoma	WA	Active
DSH500129AH	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Nuclear Medicine Allenmore C	3124 South 19th St Suite 100	Tacoma	WA	Active
DSH500129AJ	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore Heart and Lung Center	1901 South Union Ave	Tacoma	WA	Active
DSH500129AK	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV SHORT STAY UNIT	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129AL	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH HSD CT SCAN	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AM	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH PACU	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AN	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH OR	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AP	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH HSD RADIATION THERAPY	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AQ	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH HSD MRI	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AR	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH HSD DIABETES SVCS	4545 Point Fosdick Rd NW	Gig Harbor	WA	Active
DSH500129AS	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH HSD DIAGNOSTIC IMAGING	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AT	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH PHARMACEUTICAL RESOURCE CLINIC	4545 Point Fosdick Drive NW, STE 260	Gig Harbor	WA	Terminated
DSH500129AU	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH ONC ACUPUNCTURE	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AV	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH MULTI-SPECIALTY PROCEDURE CENTER	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AW	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH SURGICAL ADMISSION UNIT	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129AX	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - GH ONC BREAST SURGEONS	4545 Point Fosdick Drive NW	Gig Harbor	WA	Active
DSH500129BA	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AUB HSD RADIATION THERAPY	121 North Division St #100	AUBURN	WA	Active
DSH500129BB	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AUB ONC BREAST SURGEONS	121 North Division St #100	AUBURN	WA	Active
DSH500129BC	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AUB HSD HEM/ONC LAB	121 North Division St #100	AUBURN	WA	Terminated
DSH500129BD	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AUB ONC INTERNAL MEDICINE	121 North Division St #100/200	AUBURN	WA	Active
DSH500129BF	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV PACU 1	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129BG	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV PACU 2	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129BH	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV HSD MRI	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129BK	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV HSD ULTRASOUND	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129BM	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV EMERGENCY DEPARTMENT	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129BP	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AH DIAGNOSTIC IMAGING	1901 South Union	TACOMA	WA	Active
DSH500129BQ	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - TG INTERVENTIONAL ENDOSCOPY	316 Martin Luther King Jr Way	TACOMA	WA	Active
DSH500129BR	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AH INTERVENTIONAL ENDOSCOPY	1901 South Union	TACOMA	WA	Active
DSH500129BS	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AH ULTRASOUND	1901 South Union	TACOMA	WA	Active
DSH500129BT	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - TG WG WESTGATE LAB	2209 North Pearl Suite 100	TACOMA	WA	Terminated
DSH500129BU	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AHC CLAB ALLENMORE C LAB	3124 S 19th Street	TACOMA	WA	Terminated
DSH500129BV	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - TG BAKER DIAGNOSTIC IMAGING	316 Martin Luther King Jr Way	TACOMA	WA	Active
DSH500129BW	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - TG TRAUMA FOLLOWUP - BAKER	316 MARTIN LUTHER KING JR.WAY	TACOMA	WA	Active
DSH500129BX	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - MB LAB	317 Martin Luther King Jr Way	TACOMA	WA	Terminated
DSH500129BY	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - TG LAKEWOOD DIABETES SERVICES	735 12th Street SE	AUBURN	WA	Terminated
DSH500129BZ	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV OR	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129CA	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - TG SPANAWAY DIABETES SERVICES	225 176th St S	SPANAWAY	WA	Terminated
DSH500129CB	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV HSD DIAGNOSTIC IMAGING	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129CC	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AH DIABETES SERVICES	3124 South 19th, Suite 140	TACOMA	WA	Terminated
DSH500129CD	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AH NUCLEAR MED	1901 South Union	TACOMA	WA	Active
DSH500129CE	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV HSD CT SCAN	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129CF	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AH ECHO	1901 South Union-	TACOMA	WA	Active
DSH500129CG	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - COV HSD DIABETES SVCS	17700 SE 272nd St.	COVINGTON	WA	Terminated
DSH500129CH	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AH Medication Management Clinic	1901 South Union- BUILDING B, SUITE #7009	TACOMA	WA	Active
DSH500129CJ	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE HEALTH SYSTEM - AUB HSD DIABETES SERVICES	735 12th Street SE	AUBURN	WA	Terminated
DSH500129CK	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MultiCare Neuroscience & Sleep Medicine - TG Neurology	915 6th Avenue	Tacoma	WA	Active
DSH500129CL	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Multicare Rheumatology Specialists - Multicare Rheumatology Specialists	1901 S. Cedar St.	Tacoma	WA	Active
DSH500129CM	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MultiCare Neuroscience & Sleep Medicine - TG NEUROSURGERY CLINIC	915 6TH Ave	Tacoma	WA	Active
DSH500129CN	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Tacoma General Emergency - Federal Way - TG Off Campus ED - FW	29805 Pacific Hwy S	Federal Way	WA	Active
DSH500129CP	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore Hospital PET/CT - AHC PET/CT	3124 S 19th	Tacoma	WA	Active
DSH500129E	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Tacoma Family Medicine Clinic	521 MARTIN LUTHER KING JR WAY	TACOMA	WA	Terminated
DSH500129F	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE REGIONAL CANCER CENTER - GIG HARBOR	4545 POINT FOSDICK DR NW Suite 215	GIG HARBOR	WA	Active
DSH500129G	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE REGIONAL CANCER CENTER - AUBURN	121 N. Division Street Suite 100	AUBURN	WA	Active
DSH500129H	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	MULTICARE REGIONAL CANCER CENTER - PUYALLUP	400 15TH AVE SE	PUYALLUP	WA	Active
DSH500129J	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Baker Center Ambulatory Surgery Center	316 Martin Luther King Jr Way	Tacoma	WA	Active
DSH500129K	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Day Surgery of Tacoma-PACU	316 Martin Luther King Jr Way	Tacoma	WA	Active
DSH500129L	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Interventional Pain Management	316 Martin Luther King Jr Way	Tacoma	WA	Active
DSH500129M	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	OB Access Clinic	521 Martin Luther King Jr Way	Tacoma	WA	Terminated
DSH500129Q	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore Campus	1901 S Union Ave	Tacoma	WA	Active
DSH500129R	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore Short Stay Unit	1901 S Union Ave	Tacoma	WA	Active
DSH500129S	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore Emergency Department	1901 S Union Ave	Tacoma	WA	Active
DSH500129T	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore Surgery (Operating Room)	1901 S Union Ave	Tacoma	WA	Active
DSH500129U	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore PACU	1901 S Union Ave	Tacoma	WA	Active
DSH500129W	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore MRI	1901 S Union Ave	Tacoma	WA	Active
DSH500129X	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore Radiology	1901 S Union Ave	Tacoma	WA	Active
DSH500129Y	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore CT Scan	1901 S Union Ave	Tacoma	WA	Active
DSH500129Z	Child	DSH	TACOMA GENERAL/ALLENMORE HOSPITAL	Allenmore Interventional Radiology	1901 S Union Ave	Tacoma	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 12:20:51 PM	8/18/2024 7:40:27 PM	8/18/2024 7:40 PM
Details	Last Recertification Date	Update	Recertification	9/9/2022 6:13:24 PM	9/5/2023 12:20:51 PM	9/5/2023 12:20 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	11/4/2022 8:08 AM
Details	Last Recertification Date	Update	Recertification	9/3/2021 9:13:08 AM	9/9/2022 6:13:24 PM	9/9/2022 6:13 PM
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	Change Request	Campanella, Maria Director 340B Program MultiCare Health System 2534038314	Wilson, Cindy Director Pharmacy Compliance MultiCare Health System 2534032822	10/26/2021 1:40 PM
Addresses	Billing Address	Update	Recertification	MULTICARE HEALTH SYSTEM 737 South Fawcett MS: 737-4-AP TACOMA, WA 98415	MULTICARE HEALTH SYSTEM PO Box 5299 MS 1313-5-AP TACOMA, WA 98415-0299	9/3/2021 9:13 AM
Contacts	Primary Contact	Update	Recertification	Scheer, LeeAnn Director of Pharmacy Supply Chain and 340B Multicare Health System 5127898341	Campanella, Maria Director 340B Program MultiCare Health System 2534038314	9/3/2021 9:13 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 1:54:39 AM	9/3/2021 9:13:08 AM	9/3/2021 9:13 AM
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
Addresses	Billing Address	Update	Recertification	MULTICARE HEALTH SYSTEM PO BOX 5299 MS:737-4-AP TACOMA, WA 98415	MULTICARE HEALTH SYSTEM 737 South Fawcett MS: 737-4-AP TACOMA, WA 98415	9/9/2020 1:54 AM
Medicaid Billing	NPI: State	Update	Recertification		WA	9/9/2020 1:54 AM
Medicaid Billing	NPI: State	Update	Recertification		WA	9/9/2020 1:54 AM
Details	Last Recertification Date	Update	Recertification	9/9/2019 1:24:15 AM	9/9/2020 1:54:39 AM	9/9/2020 1:54 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	3/10/2020 2:05 PM
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	11/27/2019 9:27 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1093802290 ( )		11/8/2019 12:37 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306933213 ( )		11/8/2019 12:37 AM
Medicaid Billing	Medicaid: Number	Update	Recertification	500129	1043908	9/9/2019 1:24 AM
Details	Last Recertification Date	Update	Recertification	8/18/2018 2:31:12 PM	9/9/2019 1:24:15 AM	9/9/2019 1:24 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		1093802290	12/12/2018 12:38 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306933213	12/12/2018 12:38 AM
Details	Last Recertification Date	Update	Recertification		8/18/2018 2:31:12 PM	8/18/2018 2:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/3/2018 1:37 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500129	8/3/2018 1:37 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		WA	8/3/2018 1:37 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1841741311	8/3/2018 1:37 AM
Details	State	Update		Approved	Active	1/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Chang, Florence Executive Vice President MULTICARE HEALTH SYSTEM 2534037355	11/8/2017 2:14 PM
Details	340B ID	Update	New Registration		DSH500129AQ	11/8/2017 2:14 PM
Details	Entity Subname	Update	New Registration	MULTICARE HEALTH SYSTEM	MULTICARE HEALTH SYSTEM - GH HSD MRI	11/8/2017 2:14 PM
Dates	Participating Approval Date	Update	New Registration		11/8/2017 2:14:09 PM	11/8/2017 2:14 PM
Details	State	Update	New Registration	Pending	Approved	11/8/2017 2:14 PM
Dates	Signed By Date	Update	New Registration		10/13/2017 2:42:53 AM	11/8/2017 2:14 PM
Dates	Start Date	Update	New Registration		1/1/2018 12:00:00 AM	11/8/2017 2:14 PM
Addresses	Main Address	Insert	New Registration		4545 Point Fosdick Drive NW Gig Harbor, WA 98335	10/12/2017 6:18 PM
Addresses	Billing Address	Insert	New Registration		MULTICARE HEALTH SYSTEM PO BOX 5299 MS:737-4-AP TACOMA, WA 98415	10/12/2017 6:18 PM
Addresses	Shipping Address	Insert	New Registration		MULTICARE HEALTH SYSTEM 315 MARTIN LUTHER KING JR. WAY TACOMA, WA 98405	10/12/2017 6:18 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1366556227	10/12/2017 6:18 PM
Contacts	Authorizing Official	Insert	New Registration		Chang, Florence Executive Vice President MULTICARE HEALTH SYSTEM 2534037355	10/12/2017 6:18 PM
Contacts	Primary Contact	Insert	New Registration		Aflatooni, Vafa Pharmacy Manager MultiCare Health System 2534032082	10/12/2017 6:18 PM
Details	Last Recertification Date	Insert	New Registration			10/12/2017 6:18 PM
Details	Grant Number	Insert	New Registration			10/12/2017 6:18 PM
Details	340B ID	Insert	New Registration			10/12/2017 6:18 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2017 6:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2017 6:18 PM
Details	Medicare Provider Number	Insert	New Registration		500129	10/12/2017 6:18 PM
Details	Entity Name	Insert	New Registration		TACOMA GENERAL/ALLENMORE HOSPITAL	10/12/2017 6:18 PM
Details	Program Code	Insert	New Registration		DSH	10/12/2017 6:18 PM
Details	Entity Subname	Insert	New Registration		MULTICARE HEALTH SYSTEM	10/12/2017 6:18 PM
Dates	Participating Approval Date	Insert	New Registration			10/12/2017 6:18 PM
Details	State	Insert	New Registration		Pending	10/12/2017 6:18 PM
Dates	Registration Date	Insert	New Registration		10/12/2017 6:18:32 PM	10/12/2017 6:18 PM
Dates	Signed By Date	Insert	New Registration			10/12/2017 6:18 PM
Dates	Start Date	Insert	New Registration			10/12/2017 6:18 PM
Terminations	Termination Comments	Insert	New Registration			10/12/2017 6:18 PM
Terminations	Termination Date	Insert	New Registration			10/12/2017 6:18 PM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2017 6:18 PM
Terminations	Termination Reason	Insert	New Registration			10/12/2017 6:18 PM