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SKAGIT REGIONAL HEALTH PHARMACY
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
SKAGIT REGIONAL HEALTH PHARMACY
Pharmacy Address
1400 E KINCAID ST
MOUNT VERNON, WA 98274
Pharmacy Comments
Contract Details
Approval Date
1/6/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tamara L Cesena, Chief Financial Officer
(360) 445-8512
Contract Pharmacy Representative
Skagit Regional Health
Keith Fongemie, Director
(360) 428-2425
Signed By Date
1/6/2025
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