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OPTION CARE ENTERPRISES, INC.
DSH500053 KENNEWICK GENERAL HOSPITAL
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Covered Entity Details
Entity Name
KENNEWICK GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500053
Entity Address
900 S AUBURN STREET
KENNEWICK, WA 99336
Medicare Provider Number
500053
Participating Start Date
10/1/2004
Last Recertification Date
12/6/2017
Entity Termination Date
10/1/2018
Pharmacy Details
Pharmacy Name
OPTION CARE ENTERPRISES, INC.
Pharmacy Address
D/B/A OPTION CARE
3310 N. PINES RD.
SPOKANE VALLEY, WA 99206-2804
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Tony Sudduth, CFO
(509) 221-5349
Contract Pharmacy Representative
Option Care
Shanna Brown, Business Analyst
(602) 453-2013
Signed By Date
4/14/2017
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