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ACARIAHEALTH PHARMACY #11, INC
DSH500003 SKAGIT VALLEY HOSPITAL
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Covered Entity Details
Entity Name
SKAGIT VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500003
Entity Address
1415 EAST KINCAID
MOUNT VERNON, WA 98274-4126
Medicare Provider Number
500003
Participating Start Date
7/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY #11, INC
Pharmacy Address
1311 W SAM HOUSTON PKWY N STE 130
HOUSTON, TX 77043-4015
Pharmacy Comments
Contract Details
Approval Date
10/25/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/16/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Ishizuka, CFO
(360) 814-5838
Contract Pharmacy Representative
Acariahealth Pharmacy, Inc
Rob Jarvis, Vice President, Pharmacy Relations & Business Strategy
(304) 552-4119
Signed By Date
10/25/2018
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