Contract Pharmacy Details

PUBLIC HEALTH
TB985047 WASHINGTON STATE DEPARTMENT OF HEALTH

Covered Entity Details

Entity Name

WASHINGTON STATE DEPARTMENT OF HEALTH

Subdivision Name

TB Program

Type

Tuberculosis

340B ID

TB985047

Entity Address

1610 NE 150th Street
MS K17-9
Shoreline, WA 98155

Grant Number

NU52PS910277

Participating Start Date

1/1/2001

Last Recertification Date

5/5/2025

Pharmacy Details

Pharmacy Name

PUBLIC HEALTH

Pharmacy Address

DOWNTOWN CENTRAL PHARMACY
2124 4TH AVE
SEATTLE, WA 98121

Pharmacy Comments

Contract Details

Approval Date

1/24/2012

Contract Begin Date

1/24/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/1/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Sheanne Allen, TB CONTROLLER
(360) 236-3423

Contract Pharmacy Representative

Benjamin Leifer, Chief Administrative Officer
(206) 263-8696

Signed By Date

12/9/2011

340B Drug Pricing Program Database