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PED503301-24 Mary Bridge Children's Hospital and Health Center (Active)
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Main Details
Name
Mary Bridge Children's Hospital and Health Center
Subdivision Name
MB TAC GENETICS CLINIC - Genetics
Type
Children's Hospital
Rural
No
340B ID
PED503301-24
Medicare Provider Number
503301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/17/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/8/2019
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
311 South "L" Street
TACOMA, WA 98405
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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