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FRED MEYER STORES
DSH500030 ST. JOSEPH MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. JOSEPH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500030
Entity Address
2901 SQUALICUM PARKWAY
BELLINGHAM, WA 98225-1851
Medicare Provider Number
500030
Participating Start Date
10/1/2018
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
FRED MEYER STORES
Pharmacy Address
800 LAKEWAY DRIVE
BELLINGHAM, WA 98229
Pharmacy Comments
Contract Details
Approval Date
8/30/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DALE ZENDER, CEO
(360) 788-6313
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
8/30/2018
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