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KMART OF WA LLC 4253
CH101020 Sea Mar Community Health Centers
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Covered Entity Details
Entity Name
Sea Mar Community Health Centers
Subdivision Name
Sea Mar CHC - Administration
Type
HRSA-Funded Health Center
340B ID
CH101020
Entity Address
1040 S. Henderson St.
Seattle, WA 98108
Grant Number
H80CS00445
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
KMART OF WA LLC 4253
Pharmacy Address
1414 E 72ND ST
TACOMA, WA 98404
Pharmacy Comments
Contract Details
Approval Date
7/1/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Mary Bartolo, VP, Deputy Director
(206) 763-5277
Contract Pharmacy Representative
Sears
Jennifer Speares, Director of Administration and Compliance
(847) 286-5116
Signed By Date
7/1/2016
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