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ST JOSEPH'S MCAULEY PHARMACY
RRC500039-00 ST. MICHAEL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. MICHAEL MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC500039-00
Entity Address
1800 NW MYHRE ROAD
SILVERDALE, WA 98383
Medicare Provider Number
500039
Participating Start Date
1/1/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ST JOSEPH'S MCAULEY PHARMACY
Pharmacy Address
500 W. THOMAS ROAD
SUITE 190
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/22/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mike Fitzgerald, CFO
(253) 680-4005
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
7/9/2020
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