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VIRGINIA MASON GEORGETOWN PHARMACY
DSH500036 YAKIMA VALLEY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
YAKIMA VALLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500036
Entity Address
2811 TIETON DR.
YAKIMA, WA 98902
Medicare Provider Number
500036
Participating Start Date
12/1/1992
Last Recertification Date
8/17/2024
Pharmacy Details
Pharmacy Name
VIRGINIA MASON GEORGETOWN PHARMACY
Pharmacy Address
5959 CORSON AVE S
STE C-1
SEATTLE, WA 98108
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Timothy Reed, CFO
(509) 574-5965
Contract Pharmacy Representative
Virginia Mason
Kristine Crawford, Manager
(206) 341-3300
Signed By Date
4/15/2020
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