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SWEDISH EDMONDS
DSH500026 SWEDISH EDMONDS
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Covered Entity Details
Entity Name
SWEDISH EDMONDS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500026
Entity Address
21601 76TH AVENUE WEST
EDMONDS, WA 98026-7507
Medicare Provider Number
500026
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
SWEDISH EDMONDS
Pharmacy Address
PAVILION PHARMACY
7320 216TH STREET SW
SUITE 100
EDMONDS, WA 98026-8006
Pharmacy Comments
Contract Details
Approval Date
11/18/2010
Contract Begin Date
11/18/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/9/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICK CANNING, COO/CFO
(425) 640-4113
Contract Pharmacy Representative
JAMES LEE BAKER, PHARMACY DIRECOR
(425) 673-3701
Signed By Date
11/16/2010
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