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BARTELL DRUGS #06951
DSH500003 SKAGIT VALLEY HOSPITAL
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Covered Entity Details
Entity Name
SKAGIT VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500003
Entity Address
1415 EAST KINCAID
MOUNT VERNON, WA 98274-4126
Medicare Provider Number
500003
Participating Start Date
7/1/2006
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
BARTELL DRUGS #06951
Pharmacy Address
6602- 64TH STREET N.E.
MARYSVILLE, WA 98270
Pharmacy Comments
Contract Details
Approval Date
7/11/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
THOMAS LITAKER, CFO
(360) 445-8505
Contract Pharmacy Representative
Peter Koo, Senior Vice President of Pharmacy
(206) 767-1316
Signed By Date
7/11/2016
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