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CENTERWELL PHARMACY, INC.
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
CENTERWELL PHARMACY, INC.
Pharmacy Address
11010 FLORIDA CROWN DRIVE, SUITE 200
ORLANDO, FL 32824
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Tamara L Cesena, Chief Financial Officer
(360) 445-8512
Contract Pharmacy Representative
Centerwell Specialty
Natalie Bedford, Senior Vice President
(502) 580-4855
Signed By Date
10/9/2023
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