Contract Pharmacy Details

BARTELL DRUGS #19
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

BARTELL DRUGS #19

Pharmacy Address

3902 "A" STREET SE
AUBURN, WA 98002

Pharmacy Comments

Contract Details

Approval Date

8/6/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2019
Pharmacy closed

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

340B Drug Pricing Program Database