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PED503301-18 Mary Bridge Children's Hospital and Health Center (Terminated)
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Main Details
Name
Mary Bridge Children's Hospital and Health Center
Subdivision Name
MB SEDATION SERVICES - MB SEDATION SERVICES
Type
Children's Hospital
Rural
No
340B ID
PED503301-18
Medicare Provider Number
503301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/23/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/31/2017
Last Recertification Date
9/9/2019
Termination Date
Termination Reason
7/1/2020
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
MULTICARE HEALTH SYSTEM
Florence Chang, President
(253) 403-7355
Primary Contact
Multicare Health System
LeeAnn Scheer, Director of Pharmacy Supply Chain and 340B
(512) 789-8341
Addresses
Street Address
317 Martin Luther King Jr Way
TACOMA, WA 98405
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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