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YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIAT
DSH500129 TACOMA GENERAL/ALLENMORE HOSPITAL
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Covered Entity Details
Entity Name
TACOMA GENERAL/ALLENMORE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500129
Entity Address
315 MARTIN LUTHER KING JR WAY
TACOMA, WA 98405-4234
Medicare Provider Number
500129
Participating Start Date
12/1/2005
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIAT
Pharmacy Address
MULTICARE CANCER CENTER PHARMACY - NORTH
808 N. 39TH AVE
YAKIMA, WA 98902
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Wayne Lynch, Sr. VP, Chief Administrative Officer
(253) 403-2824
Contract Pharmacy Representative
Yakima Valley Memorial Hospital
Michael Hull, AVP Pharmacy Business Development and Operations
(509) 249-5227
Signed By Date
1/16/2024
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