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VALU DRUGS
DSH500079 GOOD SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500079
Entity Address
401 15th Avenue SE
PUYALLUP, WA 98372
Medicare Provider Number
500079
Participating Start Date
1/1/2022
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
VALU DRUGS
Pharmacy Address
201 E PIONEER AVE
MONTESANO, WA 98563
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
West Main Pharmacy
Jeff Harell, Managing Member
(541) 772-2330
Signed By Date
1/16/2024
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