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FRED MEYER STORES
DSH500015 MULTICARE AUBURN MEDICAL CENTER
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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 STORES
Pharmacy Address
ATTN: PHARMACY
4505 SO 19TH
TACOMA, WA 98405
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
4/14/2023
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
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