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FRED MEYER STORES INC
CH102520 Seattle Roots Community Health
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Covered Entity Details
Entity Name
Seattle Roots Community Health
Subdivision Name
Seattle Roots at Country Doctor
Type
HRSA-Funded Health Center
340B ID
CH102520
Entity Address
500 19th Ave E
Seattle, WA 98112-4007
Grant Number
H80CS00647
Participating Start Date
1/1/1998
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
FRED MEYER STORES INC
Pharmacy Address
FRED MEYER PHARMACY 13
18325 AURORA AVE N
SHORELINE, WA 98133-4417
Pharmacy Comments
Contract Details
Approval Date
7/22/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/16/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
LINDA MCVEIGH, CEO
(206) 299-1628
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/22/2015
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