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BARTELL DRUGS #06947
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
BARTELL DRUGS #06947
Pharmacy Address
WILDERNESS VILLAGE
22117 SE 237TH ST
MAPLE VALLEY, WA 98038
Pharmacy Comments
Contract Details
Approval Date
8/6/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul Hayes, Executive Vice President
(425) 228-3440 Ext: 4081
Contract Pharmacy Representative
Peter Koo, Senior Vice President of Pharmacy
(206) 767-1316
Signed By Date
8/6/2014
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