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MULTICARE CLINIC PHARMACY
PED503301-00 Mary Bridge Children's Hospital and Health Center
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Covered Entity Details
Entity Name
Mary Bridge Children's Hospital and Health Center
Subdivision Name
Type
Children's Hospital
340B ID
PED503301-00
Entity Address
317 Martin Luther King Jr Way
Tacoma, WA 98405-4234
Medicare Provider Number
503301
Participating Start Date
10/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
MULTICARE CLINIC PHARMACY
Pharmacy Address
521 Martin Luther King Jr Way
Tacoma, WA 98405
Pharmacy Comments
Contract Details
Approval Date
4/17/2020
Contract Begin Date
4/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Multicare Health System
Teresa Harberg, Director of Ambulatory Pharmacy
(253) 403-2283
Signed By Date
4/17/2020
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