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BARTELL DRUGS #06917
CAH501338-00 PUBLIC HOSPITAL DISTRICT #4 KING COUNTY WASHINGTON
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Covered Entity Details
Entity Name
PUBLIC HOSPITAL DISTRICT #4 KING COUNTY WASHINGTON
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH501338-00
Entity Address
9801 Frontier Ave SE
SNOQUALMIE, WA 98065
Medicare Provider Number
501338
Participating Start Date
7/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
BARTELL DRUGS #06917
Pharmacy Address
248 BENDIGO BLVD S
NORTH BEND, WA 98045-8134
Pharmacy Comments
Contract Details
Approval Date
1/9/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/21/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
THOMAS S. PARKER, CEO
(425) 831-2364
Contract Pharmacy Representative
Bartell Drugs
Marla Gunn, District Manager
(206) 767-1351
Signed By Date
1/9/2018
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