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THE PRESCRIPTION PAD PHARMACY - NORTH
DSH500088 PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500088
Entity Address
400 S 43RD STREET
RENTON, WA 98055-5010
Medicare Provider Number
500088
Participating Start Date
10/4/2005
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
THE PRESCRIPTION PAD PHARMACY - NORTH
Pharmacy Address
3915 TALBOT RD S
RENTON, WA 98055-5738
Pharmacy Comments
7/11/11 UPDATED ADD (WAS 4011 TALBOT RD S)
Contract Details
Approval Date
6/24/2010
Contract Begin Date
6/24/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/21/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
LARRY SMITH, CHIEF FINANCIAL OFFICER
(525) 228-3440
Contract Pharmacy Representative
Peter Tran, PHARMACIST IN CHARGE
(425) 656-4050
Signed By Date
6/15/2010
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