340B Drug Pricing Program Database
CREDENA HEALTH LLC
DSH500054 PROVIDENCE HEALTH & SERVICES - WASHINGTON - information as of 5/3/2025 11:42:34 PM
Covered Entity Details
Entity Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
PROVIDENCE SACRED HEART MEDICAL CENTER AND CHILDREN'S HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH500054
Entity Address
101 WEST 8TH AVENUE
SPOKANE, WA 99204
Medicare Provider Number
500054
Participating Start Date
1/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH LLC
Pharmacy Address
7376 SW DURHAM RD
PORTLAND, OR 97224
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shelby D Stokoe, CFO Providence Health Care
(509) 474-4949
Contract Pharmacy Representative
Providence
Tammy Pierce, Director of Pharmacy
(503) 962-1700
Signed By Date
10/13/2022
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