Contract Pharmacy Details

FRED MEYER #665
DSH500015 MULTICARE AUBURN MEDICAL CENTER

Covered Entity Details

Entity Name

MULTICARE AUBURN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500015

Entity Address

202 NORTH DIVISION STREET
AUBURN, WA 98001

Medicare Provider Number

500015

Participating Start Date

1/1/2015

Last Recertification Date

8/18/2024

Pharmacy Details

Pharmacy Name

FRED MEYER #665

Pharmacy Address

1201 VALLEY AVENUE E.
SUMNER, WA 98390

Pharmacy Comments

Contract Details

Approval Date

4/7/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Florence Chang, President
(253) 403-7355

Contract Pharmacy Representative

Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875

Signed By Date

4/7/2020

340B Drug Pricing Program Database