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MULTICARE DEACONESS RETAIL PHARMACY
PED503301-00 Mary Bridge Children's Hospital and Health Center
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Covered Entity Details
Entity Name
Mary Bridge Children's Hospital and Health Center
Subdivision Name
Type
Children's Hospital
340B ID
PED503301-00
Entity Address
317 Martin Luther King Jr Way
Tacoma, WA 98405-4234
Medicare Provider Number
503301
Participating Start Date
10/1/2011
Last Recertification Date
8/14/2024
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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