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MADRONA PHARMACY
DSH500021 ST. CLARE HOSPITAL
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Covered Entity Details
Entity Name
ST. CLARE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500021
Entity Address
11315 BRIDGEPORT WAY SW
LAKEWOOD, WA 98499
Medicare Provider Number
500021
Participating Start Date
10/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MADRONA PHARMACY
Pharmacy Address
5959 CORSON AVE S STE C1
SEATTLE, WA 98108
Pharmacy Comments
Contract Details
Approval Date
4/11/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Nosacka, SVP and CFO
(253) 680-4005
Contract Pharmacy Representative
Virginia Mason Franciscan Health
Hung Troung, Executive Director - Madrona Pharmacy
(206) 341-3300
Signed By Date
4/11/2024
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