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ESI MAIL PHARMACY SERVICE
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
ESI MAIL PHARMACY SERVICE
Pharmacy Address
DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Accredo
Casey Spiess, Director, 340B Business Development
(314) 486-5839
Signed By Date
4/15/2020
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