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FRED MEYER STORES
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
FRED MEYER STORES
Pharmacy Address
FRED MEYER PHARMACY #459
365 RENTON CENTER WAY SW
RENTON, WA 98057-2324
Pharmacy Comments
Contract Details
Approval Date
10/12/2011
Contract Begin Date
10/12/2011
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
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