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KELLEY-ROSS LONG TERM CARE PHARMACY
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
KELLEY-ROSS LONG TERM CARE PHARMACY
Pharmacy Address
2324 EASTLAKE AVE E STE 400
SEATTLE, WA 98102-6539
Pharmacy Comments
Contract Details
Approval Date
4/15/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Raleigh R Watts, Executive Director
(206) 299-1628
Contract Pharmacy Representative
Kelley-Ross
Alen Chen, Pharmacy Manager
(206) 838-4590
Signed By Date
4/15/2018
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