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ALBERTSON'S LLC
DSH500037 SHC Medical Center Toppenish
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Covered Entity Details
Entity Name
SHC Medical Center Toppenish
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500037
Entity Address
502 WEST 4TH AVENUE
TOPPENISH, WA 98948
Medicare Provider Number
500037
Participating Start Date
10/1/2018
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
ALBERTSON'S LLC
Pharmacy Address
SAFEWAY PHARMACY #0149
1610 W LINCOLN AVE.
YAKIMA, WA 98902-2408
Pharmacy Comments
Contract Details
Approval Date
10/8/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sierra Foster, Assistant Administrator
(509) 790-7284
Contract Pharmacy Representative
340BDirect
Thuy Le, Vice President Pharmacy Account Management
(801) 326-3150
Signed By Date
10/8/2020
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