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DSH500129BT TACOMA GENERAL/ALLENMORE HOSPITAL (Terminated)
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Main Details
Name
TACOMA GENERAL/ALLENMORE HOSPITAL
Subdivision Name
MULTICARE HEALTH SYSTEM - TG WG WESTGATE LAB
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500129BT
Medicare Provider Number
500129
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/9/2017
Last Recertification Date
Termination Date
Termination Reason
10/1/2018
Other
Contacts
Authorizing Official
MULTICARE HEALTH SYSTEM
Florence Chang, President
(253) 403-7355
Primary Contact
MultiCare Health System
Vafa Aflatooni, Director Pharmacy Supply Chain and 340B
(253) 403-2082
Addresses
Street Address
2209 North Pearl Suite 100
TACOMA, WA 98406
Billing Address
MULTICARE HEALTH SYSTEM
PO BOX 5299 MS:737-4-AP
TACOMA, WA 98415
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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