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EXPRESS SCRIPTS PHARMACY, INC.
DSH500129 TACOMA GENERAL/ALLENMORE HOSPITAL
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Covered Entity Details
Entity Name
TACOMA GENERAL/ALLENMORE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500129
Entity Address
315 MARTIN LUTHER KING JR WAY
TACOMA, WA 98405-4234
Medicare Provider Number
500129
Participating Start Date
12/1/2005
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
4750 E. 450 S.
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
1/17/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/16/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Accredo
Casey Spiess, Director, 340B Business Development
(314) 486-5839
Signed By Date
1/17/2019
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