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EVERGREEN PHARMACEUTICAL LLC
CH102520 Seattle Roots Community Health
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Covered Entity Details
Entity Name
Seattle Roots Community Health
Subdivision Name
Seattle Roots at Country Doctor
Type
HRSA-Funded Health Center
340B ID
CH102520
Entity Address
500 19th Ave E
Seattle, WA 98112-4007
Grant Number
H80CS00647
Participating Start Date
1/1/1998
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
EVERGREEN PHARMACEUTICAL LLC
Pharmacy Address
OMNICARE OF SEATTLE
12674 GATEWAY DR S
TUKWILA, WA 98168-3307
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bessie Chi, Director of Pharmacy
(206) 709-7116
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2023
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