Contract Pharmacy Details

CREDENA HEALTH PHARMACY SACRED HEART
DSH500054 PROVIDENCE HEALTH & SERVICES - WASHINGTON

Entity Name

PROVIDENCE HEALTH & SERVICES - WASHINGTON

Subdivision Name

PROVIDENCE SACRED HEART MEDICAL CENTER AND CHILDREN'S HOSPITAL

Type

Disproportionate Share Hospital

340B ID

DSH500054

Entity Address

101 WEST 8TH AVENUE
SPOKANE, WA 99204

Medicare Provider Number

500054

Participating Start Date

1/1/2005

Last Recertification Date

8/30/2023

Pharmacy Name

CREDENA HEALTH PHARMACY SACRED HEART

Pharmacy Address

101 W 8TH AVE STE 207653
SPOKANE, WA 99204-2307

Pharmacy Comments

Approval Date

10/14/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Shelby D Stokoe, CFO Providence Health Care
(509) 474-4949

Signed By Date

10/14/2019

Contract Pharmacy Representative

Providence
Tammy Pierce, Director of Pharmacy
(503) 962-1700