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ARDON HEALTH, LLC
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
ARDON HEALTH, LLC
Pharmacy Address
11835 NE GLENN WIDING DR
PORTLAND, OR 97220-9057
Pharmacy Comments
Contract Details
Approval Date
10/7/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Ardon Health
Grant E Knowles, VP
(503) 444-6501
Signed By Date
10/7/2020
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