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MULTICARE BONNEY LAKE PHARMACY
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
MULTICARE BONNEY LAKE PHARMACY
Pharmacy Address
10004 204TH AVE E, STE 1100
BONNEY LAKE, WA 98391
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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