Covered Entity Details

DSH500088AZ PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER (Approved) - information as of 5/10/2025 10:57:09 PM

Main Details

Name

PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER

Subdivision Name

VMC VDI - - PET CT

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500088AZ

Medicare Provider Number

500088

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/7/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/16/2025

Last Recertification Date

Contacts

Authorizing Official

Public Hospital District No 1 of King County
Jeannine Grinnell, Chief Executive and Financial Officer
(425) 690-3310

Primary Contact

Public Hospital District No. 1 of King County
Kenneth Kenyon, VP Pharmacy Services
(425) 690-3155

Addresses

Street Address

4033 Talbot Rd South
Suite 360
Renton, WA 98055-5714

Billing Address

Public Hospital District No. 1 of King County DBA Valley Medical Center
PO Box 50010
400 South 43rd Street
Renton, WA 98058

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
WA		1649209230

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH500088AA	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington Diabetes and Education	27500 168th Place SE	Covington	WA	Terminated
DSH500088AB	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Eye Clinic	3915 Talbot Road South	Renton	WA	Terminated
DSH500088AC	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Primary Care Clinics - Senior Care and Internal Medicine Clinic	4033 Talbot Road South	Renton	WA	Active
DSH500088AD	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Medication Management Clinic	4033 Talbot Road South	Renton	WA	Active
DSH500088AE	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - High Risk Genetics	4033 Talbot Road South	Renton	WA	Active
DSH500088AF	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Primary Care Clinics - Valley Women's Healthcare Clinic - Covington	16850 SE 272nd Street	Covington	WA	Active
DSH500088AG	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Urology Clinic	4033 Talbot Road South	Renton	WA	Active
DSH500088AH	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Sports Medicine	3915 Talbot Road South	Renton	WA	Active
DSH500088AJ	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Ear, Nose, and Throat Clinic, Covington	16850 SE 272nd St	Covington	WA	Active
DSH500088AK	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Dermatology, Maple Valley	26458 Maple Valley Black Diamond Rd SE	Maple Valley	WA	Active
DSH500088AL	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Cardiology, Covington	16850 SE 272nd St	Covington	WA	Active
DSH500088AM	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Medical Center - Ambulatory Infusion Center	4009 Talbot Road South	Renton	WA	Active
DSH500088AN	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Medical Center - Rehab Services	400 South 43rd Street	Renton	WA	Active
DSH500088AP	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Medical Center: - Radiation Oncology	400 South 43rd Street	Renton	WA	Active
DSH500088AQ	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics: Rheumatology - Renton	4033 Talbot Road South	Renton	WA	Active
DSH500088AR	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics: - Valley Neuroscience Institute (Adult)	400 South 43rd Street	Renton	WA	Active
DSH500088AS	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - - Allergy and Immunology Clinic, Covington	16850 SE 272nd Street, Suite 100	Covington	WA	Terminated
DSH500088AT	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Pulmonary Clinic, Covington	16850 SE 272nd Street, Suite 100	Covington	WA	Active
DSH500088AU	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - - Diabetes, Thyroid, and Endocrine Clinic	16850 SE 272nd Street, Suite 100	Covington	WA	Active
DSH500088AV	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Infectious Disease Clinic	4033 Talbot Road South	Renton	WA	Active
DSH500088AW	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	- Valley Medical Center - Infusion Center	4009 Talbot Road South	RENTON	WA	Active
DSH500088AX	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - - Child Psychiatry, Covington	27500 168th Place SE	Covington	WA	Active
DSH500088AY	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Urology Clinic, Covington	16850 SE 272nd St	Covington	WA	Active
DSH500088AZ	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC VDI - - PET CT	4033 Talbot Rd South	Renton	WA	Approved
DSH500088B	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Cascade Primary Care Clinic	3915 Talbot Rd South	Renton	WA	Active
DSH500088C	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington Primary Care Clinic	27500 168th Place SE	Covington	WA	Active
DSH500088D	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington Urgent Care	27500 168th Place SE	Covington	WA	Active
DSH500088E	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Rheumatology Clinic	16850 SE 272nd St	Covington	WA	Active
DSH500088F	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	North Benson Urgent Care	10555 SE Carr Rd	Renton	WA	Terminated
DSH500088G	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Kent Primary Care Clinic	24920 104th Ave SE	Kent	WA	Active
DSH500088H	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Family Medicine	3915 Talbot Road South	Renton	WA	Active
DSH500088J	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Nephrology Clinic	24920 104th Ave SE	Kent	WA	Active
DSH500088K	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Valley Podiatry Clinic	24920 104th Ave SE	Kent	WA	Terminated
DSH500088L	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Diabetes Education	24920 104th Ave SE	Kent	WA	Terminated
DSH500088M	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Correctional Medicine	3915 Talbot Road South	Renton	WA	Terminated
DSH500088N	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Midwives	16850 SE 272nd St	Covington	WA	Terminated
DSH500088P	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Maternal Fetal Medicine	4033 Talbot Road South	Renton	WA	Active
DSH500088Q	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC OP Wound Service	400 South 43rd Street	Renton	WA	Active
DSH500088R	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Endoscopy Center	17820 Talbot Rd South	Renton	WA	Active
DSH500088S	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	VMC Specialty Care Clinics - Medication Management Clinic, Covington	16850 SE 272nd St	Covington	WA	Active
DSH500088T	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington South Radiology	27500 168th Place SE	Covington	WA	Active
DSH500088U	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Covington Podiatry	27500 168th Place SE	Covington	WA	Active
DSH500088V	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Olympic Building Imaging	400 South 43rd Street	Renton	WA	Active
DSH500088W	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	The Breast Center	4033 Talbot Road South Suite 470	Renton	WA	Active
DSH500088X	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Maple Valley Primary Care	26458 Maple Valley Black Diamond Rd SE	Maple Valley	WA	Terminated
DSH500088Y	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	Maple Valley Urgent Care	26458 Maple Valley Black Diamond Rd SE	Maple Valley	WA	Active
DSH500088Z	Child	DSH	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	North Benson Podiatry Clinic	10555 SE Carr Road	Renton	WA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Grinnell, Jeannine Chief Executive and Financial Officer Public Hospital District No 1 of King County 4256903310	4/16/2025 11:47 AM
Details	340B ID	Update	New Registration		DSH500088AZ	4/16/2025 11:47 AM
Details	Entity Name	Update	New Registration	VALLEY MEDICAL CENTER	PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER	4/16/2025 11:47 AM
Details	Entity Subname	Update	New Registration	VMC VDI -	VMC VDI - - PET CT	4/16/2025 11:47 AM
Dates	Participating Approval Date	Update	New Registration		4/16/2025 11:47:47 AM	4/16/2025 11:47 AM
Details	State	Update	New Registration	Pending	Approved	4/16/2025 11:47 AM
Dates	Signed By Date	Update	New Registration		4/8/2025 3:12:21 PM	4/16/2025 11:47 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/16/2025 11:47 AM
Addresses	Main Address	Insert	New Registration		4033 Talbot Rd South Suite 360 Renton, WA 98055-5714	4/7/2025 8:21 PM
Addresses	Billing Address	Insert	New Registration		Public Hospital District No. 1 of King County DBA Valley Medical Center PO Box 50010 400 South 43rd Street Renton, WA 98058	4/7/2025 8:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1649209230	4/7/2025 8:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		WA	4/7/2025 8:21 PM
Contacts	Authorizing Official	Insert	New Registration		Grinnell, Jeannine Chief Executive and Financial Officer Public Hospital District No 1 of King County 4256903310	4/7/2025 8:21 PM
Contacts	Primary Contact	Insert	New Registration		Kenyon, Kenneth VP Pharmacy Services Public Hospital District No. 1 of King County 4256903155	4/7/2025 8:21 PM
Details	Assistance Received From Date	Insert	New Registration			4/7/2025 8:21 PM
Details	Assistance Received To Date	Insert	New Registration			4/7/2025 8:21 PM
Details	Last Recertification Date	Insert	New Registration			4/7/2025 8:21 PM
Details	Grant Number	Insert	New Registration			4/7/2025 8:21 PM
Details	340B ID	Insert	New Registration			4/7/2025 8:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/7/2025 8:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/7/2025 8:21 PM
Details	Medicare Provider Number	Insert	New Registration		500088	4/7/2025 8:21 PM
Details	Entity Name	Insert	New Registration		VALLEY MEDICAL CENTER	4/7/2025 8:21 PM
Details	NOFO Number	Insert	New Registration			4/7/2025 8:21 PM
Details	Program Code	Insert	New Registration		DSH	4/7/2025 8:21 PM
Details	Entity Subname	Insert	New Registration		VMC VDI -	4/7/2025 8:21 PM
Dates	Participating Approval Date	Insert	New Registration			4/7/2025 8:21 PM
Details	State	Insert	New Registration		Pending	4/7/2025 8:21 PM
Dates	Registration Date	Insert	New Registration		4/7/2025 8:21:31 PM	4/7/2025 8:21 PM
Dates	Signed By Date	Insert	New Registration			4/7/2025 8:21 PM
Dates	Start Date	Insert	New Registration			4/7/2025 8:21 PM
Terminations	Termination Comments	Insert	New Registration			4/7/2025 8:21 PM
Terminations	Termination Date	Insert	New Registration			4/7/2025 8:21 PM
Terminations	Termination Effective Date	Insert	New Registration			4/7/2025 8:21 PM
Terminations	Termination Reason	Insert	New Registration			4/7/2025 8:21 PM