Contract Pharmacy Details

QFC PHARMACY #879
FQHC638337A TULALIP TRIBES

Covered Entity Details

Entity Name

TULALIP TRIBES

Subdivision Name

TULALIP HEALTH CLINIC

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638337A

Entity Address

7520 Totem Beach Road
Tulalip, WA 98271

Grant Number

Participating Start Date

4/2/2020

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

QFC PHARMACY #879

Pharmacy Address

27008 92ND AVE NW
STANWOOD, WA 98292

Pharmacy Comments

Contract Details

Approval Date

7/13/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Melody Kiser, Interim Health Administrator
(360) 716-4326

Contract Pharmacy Representative

Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109

Signed By Date

7/13/2023

340B Drug Pricing Program Database