340B Drug Pricing Program Database
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PED503301-19 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 TAC NEPHROLOGY CLINIC - MB TAC NEPHROLOGY CLINIC
Type
Children's Hospital
Rural
No
340B ID
PED503301-19
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
9/5/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
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
311 South "L" Street
TACOMA, WA 98045
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
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