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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03840
14656 AMBAUM BLVD SW
BURIEN, WA 98166
Pharmacy Comments
Contract Details
Approval Date
7/14/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeannine Grinnell, Vice President of Finance
(425) 228-3440 Ext: 4268
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/14/2016
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