Contract Pharmacy Details

FRED MEYER STORES #215
DSH500088 PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER

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

FRED MEYER STORES #215

Pharmacy Address

25250 PACIFIC HWY SOUTH
KENT, WA 98032

Pharmacy Comments

Contract Details

Approval Date

10/12/2011

Contract Begin Date

10/15/2011

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/17/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul Hayes, Executive Vice President
(425) 228-3440 Ext: 4081

Contract Pharmacy Representative

Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672

Signed By Date

10/5/2011

340B Drug Pricing Program Database