Covered Entity Details

DSH500036AF YAKIMA VALLEY MEMORIAL HOSPITAL (Approved) - information as of 6/4/2025 12:03:07 PM

Main Details

Name

YAKIMA VALLEY MEMORIAL HOSPITAL

Subdivision Name

PET Scan (Valley Imaging PET Scan) - PET Scan

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH500036AF

Medicare Provider Number

500036

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/15/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/5/2025

Last Recertification Date

Contacts

Authorizing Official

Yakima Valley Memorial Hospital
Tammy K. Buyok, President and Market Leader
(509) 575-8001

Primary Contact

Yakima Valley Memorial Hospital
Jake Aaron Bradshaw, Director of Pharmacy
(509) 746-2002

Addresses

Street Address

314 S 11th Ave
Suite B
Yakima, WA 98902-3212

Billing Address

MultiCare Yakima Memorial Hospital
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		1053373480

Shipping Addresses

Shipping Address 1

PET Scan (Valley Imaging PET Scan)
314 S 11th Ave
Suite B
Yakima, WA 98902-3212

Shipping Address 2

MultiCare Yakima Memorial Hospital
2811 Tieton Dr
Yakima, WA 98902

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
DSH500036AB	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	OR at Memorial Surgi-Center - Surgical Services	3003 Tieton Drive, Suite 100	Yakima	WA	Terminated
DSH500036AC	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Ohana Mammography Services - Mammography Services	1515 West Yakima Ave	Yakima	WA	Active
DSH500036AD	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	NSL Oncology Facility - Yakima - Infusion	808 N. 39th Ave	Yakima	WA	Active
DSH500036AE	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	NSL Radiation Oncology - Radiation Therapy	808 N. 39th Ave	Yakima	WA	Active
DSH500036AF	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	PET Scan (Valley Imaging PET Scan) - PET Scan	314 S 11th Ave	Yakima	WA	Approved
DSH500036B	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	INFUSION CARE	808 N. 39th Ave	YAKIMA	WA	Active
DSH500036C	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Memorial Cornerstone Medicine	4003 Creekside Loop	Yakima	WA	Active
DSH500036D	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	The Surgi-Center at Memorial	3003 Tieton Drive	Yakima	WA	Active
DSH500036E	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Memorial Home Health & Hospice	1208 South 48th Avenue	Yakima	WA	Active
DSH500036F	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	NSL Oncology Facility Ellensburg	100 E. Jackson Avenue	Ellensburg	WA	Terminated
DSH500036G	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	NSL Oncology Facility - Sunnyside	1812 E. Edison Ave.	Sunnyside	WA	Terminated
DSH500036H	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Cancer Care Clinic	808 N. 39th Avenue	Yakima	WA	Terminated
DSH500036I	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Memorial Valley Imaging	314 S. 11th Avenue	Yakima	WA	Active
DSH500036J	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	YVMH Heart, Lung, Vascular Clinic	406 S. 30th Avenue	Yakima	WA	Active
DSH500036K	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	The Springs	302 S. 10th Avenue	Yakima	WA	Terminated
DSH500036L	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Waters Edge Pain Center	1460 N. 16th Avenue	Yakima	WA	Active
DSH500036M	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Memorial Surgery Center at Ridgeview	2500 Racquet Lane Suite #150	Yakima	WA	Active
DSH500036N	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Apple Valley Family Medicine	1008 South 38th Avenue	Yakima	WA	Active
DSH500036P	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Family Medicine of Yakima	504 North 40th Avenue	Yakima	WA	Active
DSH500036Q	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Lakeview Spine	1470 North 16th Avenue, Suite D	Yakima	WA	Active
DSH500036R	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Pacific Crest Family Medicine	311 South 72nd Avenue	Yakima	WA	Active
DSH500036S	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Selah Family Medicine	620 North Park Drive	Selah	WA	Active
DSH500036T	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Yakima Ear Nose and Throat	1601 Creekside Loop	Yakima	WA	Active
DSH500036U	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Yakima Endocrinology Associates	4003 Creekside Loop	Yakima	WA	Active
DSH500036V	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Yakima Gastroenterology Associates	4003 Creekside Loop	Yakima	WA	Active
DSH500036W	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	Yakima Vascular Associates	406 S. 30th Ave.	Yakima	WA	Terminated
DSH500036X	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	YVHH - Cottage in the Meadow (Hospice)	1208 South 48th Avenue	Yakima	WA	Terminated
DSH500036Y	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	NSL Medical Oncology - Yakima - Oncology	808 N. 39th Ave	Yakima	WA	Active
DSH500036Z	Child	DSH	YAKIMA VALLEY MEMORIAL HOSPITAL	PACU at Memorial Surgi-Center - Surgery Recovery Services	3003 Tieton Drive, Suite 100	Yakima	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Buyok, Tammy K. President and Market Leader Yakima Valley Memorial Hospital 5095758001	5/5/2025 7:59 AM
Details	340B ID	Update	New Registration		DSH500036AF	5/5/2025 7:59 AM
Details	Entity Subname	Update	New Registration	PET Scan (Valley Imaging PET Scan)	PET Scan (Valley Imaging PET Scan) - PET Scan	5/5/2025 7:59 AM
Dates	Participating Approval Date	Update	New Registration		5/5/2025 7:59:06 AM	5/5/2025 7:59 AM
Details	State	Update	New Registration	Pending	Approved	5/5/2025 7:59 AM
Dates	Signed By Date	Update	New Registration		4/15/2025 5:34:24 PM	5/5/2025 7:59 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/5/2025 7:59 AM
Addresses	Main Address	Insert	New Registration		314 S 11th Ave Suite B Yakima, WA 98902-3212	4/15/2025 5:08 PM
Addresses	Billing Address	Insert	New Registration		MultiCare Yakima Memorial Hospital PO Box 5299 MS 1313-5-AP Tacoma, WA 98415-0299	4/15/2025 5:08 PM
Addresses	Shipping Address	Insert	New Registration		PET Scan (Valley Imaging PET Scan) 314 S 11th Ave Suite B Yakima, WA 98902-3212	4/15/2025 5:08 PM
Addresses	Shipping Address	Insert	New Registration		MultiCare Yakima Memorial Hospital 2811 Tieton Dr Yakima, WA 98902	4/15/2025 5:08 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1053373480	4/15/2025 5:08 PM
Medicaid Billing	NPI: State	Insert	New Registration		WA	4/15/2025 5:08 PM
Contacts	Authorizing Official	Insert	New Registration		Buyok, Tammy K. President and Market Leader Yakima Valley Memorial Hospital 5095758001	4/15/2025 5:08 PM
Contacts	Primary Contact	Insert	New Registration		Bradshaw, Jake Aaron Director of Pharmacy Yakima Valley Memorial Hospital 5097462002	4/15/2025 5:08 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2025 5:08 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2025 5:08 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2025 5:08 PM
Details	Grant Number	Insert	New Registration			4/15/2025 5:08 PM
Details	340B ID	Insert	New Registration			4/15/2025 5:08 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2025 5:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2025 5:08 PM
Details	Medicare Provider Number	Insert	New Registration		500036	4/15/2025 5:08 PM
Details	Entity Name	Insert	New Registration		YAKIMA VALLEY MEMORIAL HOSPITAL	4/15/2025 5:08 PM
Details	NOFO Number	Insert	New Registration			4/15/2025 5:08 PM
Details	Program Code	Insert	New Registration		DSH	4/15/2025 5:08 PM
Details	Entity Subname	Insert	New Registration		PET Scan (Valley Imaging PET Scan)	4/15/2025 5:08 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2025 5:08 PM
Details	State	Insert	New Registration		Pending	4/15/2025 5:08 PM
Dates	Registration Date	Insert	New Registration		4/15/2025 5:08:04 PM	4/15/2025 5:08 PM
Dates	Signed By Date	Insert	New Registration			4/15/2025 5:08 PM
Dates	Start Date	Insert	New Registration			4/15/2025 5:08 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2025 5:08 PM
Terminations	Termination Date	Insert	New Registration			4/15/2025 5:08 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2025 5:08 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2025 5:08 PM