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CORAM ALTERNATE SITE SERVICES, INC.
DSH500054 PROVIDENCE HEALTH & SERVICES - WASHINGTON
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
PROVIDENCE SACRED HEART MEDICAL CENTER AND CHILDREN'S HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH500054
Entity Address
101 WEST 8TH AVENUE
SPOKANE, WA 99204
Medicare Provider Number
500054
Participating Start Date
1/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CORAM ALTERNATE SITE SERVICES, INC.
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
5511 E 3RD AVE
SPOKANE VALLEY, WA 99212-0726
Pharmacy Comments
Contract Details
Approval Date
7/25/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Helen Andrus, CFO
(509) 474-3307
Contract Pharmacy Representative
CVS Health/Specialty
Jen Jagodzinski, Senior Director, Specialty Product Development
(847) 559-4702
Signed By Date
7/25/2017
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