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FRED MEYER STORES
DSH500036 YAKIMA VALLEY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
YAKIMA VALLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500036
Entity Address
2811 TIETON DR.
YAKIMA, WA 98902
Medicare Provider Number
500036
Participating Start Date
12/1/1992
Last Recertification Date
8/17/2024
Pharmacy Details
Pharmacy Name
FRED MEYER STORES
Pharmacy Address
1206 NORTH 40TH AVENUE
YAKIMA, WA 98908
Pharmacy Comments
Contract Details
Approval Date
1/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SCOTT OLANDER, CHIEF FINANCIAL OFFICER
(509) 249-5201
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
1/4/2013
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