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MULTICARE DEACONESS RETAIL PHARMACY
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
MULTICARE DEACONESS RETAIL PHARMACY
Pharmacy Address
910 W 5TH AVE, STE 270
SPOKANE, WA 99204
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
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
MultiCare Health System
Teresa Harberg, AVP Ambulatory Pharmacy Services
(253) 403-2283
Signed By Date
4/15/2025
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