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FRANCISCAN PHARMACY ST. CLARE
DSH500021 ST. CLARE HOSPITAL
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Covered Entity Details
Entity Name
ST. CLARE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500021
Entity Address
11315 BRIDGEPORT WAY SW
LAKEWOOD, WA 98499
Medicare Provider Number
500021
Participating Start Date
10/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
FRANCISCAN PHARMACY ST. CLARE
Pharmacy Address
ATT. ESHETU GULILAT
11315 BRIDGEPORT WAY SW # A1087
LAKEWOOD, WA 98499
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mike Fitzgerald, CFO
(253) 680-4005
Contract Pharmacy Representative
CHI Franciscan Health
Olga Maslova, Ambulatory Services Market Manager
(253) 426-6209
Signed By Date
7/15/2020
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