Covered Entity Details

DSH500044M DEACONESS MEDICAL CENTER (Approved) - information as of 5/12/2025 10:08:57 PM

Main Details

Name

DEACONESS MEDICAL CENTER

Subdivision Name

Post Anesthesia Care Deaconess - PACU DHS

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500044M

Medicare Provider Number

500044

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/14/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/5/2025

Last Recertification Date

Contacts

Authorizing Official

MultiCare Health System
Timothy Wayne Lynch, Sr. VP, Chief Administrative Officer
(253) 403-2824

Primary Contact

MultiCare Health System
Cindy Wilson, Assistant Vice President - Pharmacy Compliance
(253) 403-2822

Addresses

Street Address

910 W 5TH AVE STE 400
SPOKANE, WA 99204

Billing Address

MultiCare Deaconess Medical Center
PO Box: 5299
MS 1313-5-AP
Tacoma, WA 98415-0299

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		1356528269
ID		1356528269

Shipping Addresses

Shipping Address 1

Deaconess Medical Center
800 W 5th Avenue
Spokane, WA 99204

Shipping Address 2

PACU Deaconess
910 W 5TH AVE STE 400
Spokane, WA 99204

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
DSH500044A	Child	DSH	DEACONESS MEDICAL CENTER	DEM MRI - Radiology-Diagnostic	910 W. 5th Ave., Suite 150	Spokane	WA	Active
DSH500044B	Child	DSH	DEACONESS MEDICAL CENTER	DEM FSED - Emergency	8202 N. Division Street	Spokane	WA	Active
DSH500044C	Child	DSH	DEACONESS MEDICAL CENTER	DEM ACI- Northpointe - Radiology-Diagnostic	605 E. Holland Ave., Suite 218	Spokane	WA	Active
DSH500044D	Child	DSH	DEACONESS MEDICAL CENTER	DEM ACI-Coeur d' Alene - Radiology-Diagnostic	980 W. Ironwood Drive	Coeur d'Alene	ID	Active
DSH500044E	Child	DSH	DEACONESS MEDICAL CENTER	DEM ACI-DHEC - Radiology-Diagnostic	910 W. 5th Ave., Suite 901	Spokane	WA	Active
DSH500044F	Child	DSH	DEACONESS MEDICAL CENTER	Breast Surgery DHS - Breast Surgery Clinic	910 W 5th Ave., Suite 700	Spokane	WA	Active
DSH500044G	Child	DSH	DEACONESS MEDICAL CENTER	Cancer&Blood Spec No Spok DHS - Cancer and Blood Specialty Clinics	309 E Farwell Rd. Suite 100	Spokane	WA	Active
DSH500044H	Child	DSH	DEACONESS MEDICAL CENTER	Cancer&Blood Spec Spokane DHS - Cancer and Blood Specialty Clinics	910 W. 5th Ave., Suite 700	Spokane	WA	Active
DSH500044J	Child	DSH	DEACONESS MEDICAL CENTER	Cancer&Blood Spec Spokane Valley DHS - Cancer and Blood Specialty Clinics	12410 E Sinto Ave. Suite 101	Spokane Valley	WA	Terminated
DSH500044K	Child	DSH	DEACONESS MEDICAL CENTER	Multicare Neuroscience Institute Neurology Center - Multicare Neuroscience Institute Neurology Center	910 W 5th Ave	Spokane	WA	Terminated
DSH500044L	Child	DSH	DEACONESS MEDICAL CENTER	DHEC PET/CT - Deaconess PET/CT	910 W. 5th Ave.	Spokane	WA	Active
DSH500044M	Child	DSH	DEACONESS MEDICAL CENTER	Post Anesthesia Care Deaconess - PACU DHS	910 W 5TH AVE STE 400	SPOKANE	WA	Approved
DSH500044N	Child	DSH	DEACONESS MEDICAL CENTER	Interventional Endoscopy (Digestive Health Center at Deaconess) - Endoscopy	910 W 5TH AVE STE 500	SPOKANE	WA	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Lynch, Timothy Wayne Sr. VP, Chief Administrative Officer MultiCare Health System 2534032824	5/5/2025 12:06 PM
Details	340B ID	Update	New Registration		DSH500044M	5/5/2025 12:06 PM
Details	Entity Subname	Update	New Registration	Post Anesthesia Care Deaconess	Post Anesthesia Care Deaconess - PACU DHS	5/5/2025 12:06 PM
Dates	Participating Approval Date	Update	New Registration		5/5/2025 12:06:40 PM	5/5/2025 12:06 PM
Details	State	Update	New Registration	Pending	Approved	5/5/2025 12:06 PM
Dates	Signed By Date	Update	New Registration		4/14/2025 9:00:39 PM	5/5/2025 12:06 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/5/2025 12:06 PM
Addresses	Main Address	Insert	New Registration		910 W 5TH AVE STE 400 SPOKANE, WA 99204	4/14/2025 7:56 PM
Addresses	Billing Address	Insert	New Registration		MultiCare Deaconess Medical Center PO Box: 5299 MS 1313-5-AP Tacoma, WA 98415-0299	4/14/2025 7:56 PM
Addresses	Shipping Address	Insert	New Registration		Deaconess Medical Center 800 W 5th Avenue Spokane, WA 99204	4/14/2025 7:56 PM
Addresses	Shipping Address	Insert	New Registration		PACU Deaconess 910 W 5TH AVE STE 400 Spokane, WA 99204	4/14/2025 7:56 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1356528269	4/14/2025 7:56 PM
Medicaid Billing	NPI: State	Insert	New Registration		WA	4/14/2025 7:56 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1356528269	4/14/2025 7:56 PM
Medicaid Billing	NPI: State	Insert	New Registration		ID	4/14/2025 7:56 PM
Contacts	Primary Contact	Insert	New Registration		Wilson, Cindy Assistant Vice President - Pharmacy Compliance MultiCare Health System 2534032822	4/14/2025 7:56 PM
Contacts	Authorizing Official	Insert	New Registration		Lynch, Timothy Wayne Sr. VP, Chief Administrative Officer MultiCare Health System 2534032824	4/14/2025 7:56 PM
Details	Assistance Received From Date	Insert	New Registration			4/14/2025 7:56 PM
Details	Assistance Received To Date	Insert	New Registration			4/14/2025 7:56 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2025 7:56 PM
Details	Grant Number	Insert	New Registration			4/14/2025 7:56 PM
Details	340B ID	Insert	New Registration			4/14/2025 7:56 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2025 7:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2025 7:56 PM
Details	Medicare Provider Number	Insert	New Registration		500044	4/14/2025 7:56 PM
Details	Entity Name	Insert	New Registration		DEACONESS MEDICAL CENTER	4/14/2025 7:56 PM
Details	NOFO Number	Insert	New Registration			4/14/2025 7:56 PM
Details	Program Code	Insert	New Registration		DSH	4/14/2025 7:56 PM
Details	Entity Subname	Insert	New Registration		Post Anesthesia Care Deaconess	4/14/2025 7:56 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2025 7:56 PM
Details	State	Insert	New Registration		Pending	4/14/2025 7:56 PM
Dates	Registration Date	Insert	New Registration		4/14/2025 7:56:37 PM	4/14/2025 7:56 PM
Dates	Signed By Date	Insert	New Registration			4/14/2025 7:56 PM
Dates	Start Date	Insert	New Registration			4/14/2025 7:56 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2025 7:56 PM
Terminations	Termination Date	Insert	New Registration			4/14/2025 7:56 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2025 7:56 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2025 7:56 PM