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SAFEWAY INC
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
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1246
6201 6TH AVENUE
TACOMA, WA 98406
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
SAFEWAY
Charles Hanson, 340B Program Manager
(208) 395-6304
Signed By Date
4/14/2020
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