Covered Entity Details

DSH500036D YAKIMA VALLEY MEMORIAL HOSPITAL (Active) - information as of 5/3/2025 11:27:40 PM

Main Details

Name

YAKIMA VALLEY MEMORIAL HOSPITAL

Subdivision Name

The Surgi-Center at Memorial

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500036D

Medicare Provider Number

500036

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/14/2013

Participating Start Date

1/1/2014

Participating Approval Date

12/6/2013

Last Recertification Date

8/17/2024

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

3003 Tieton Drive
Suite 100
Yakima, WA 98902

Billing Address

Yakima Valley 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	3307501,1042669	1053373480

Shipping Addresses

Shipping Address 1

Yakima Valley Memorial Hospital
2811 Tieton Drive
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
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
Addresses	Billing Address	Update	Group Change Request	Yakima Valley Memorial Hospital 2811 Tieton Drive Yakima, WA 98902	Yakima Valley Memorial Hospital PO Box: 5299 MS 1313-5-AP Tacoma, WA 98415-0299	3/7/2025 10:57 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	HS7WAOP (AK)		10/1/2024 3:26 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	220079 (OR)		10/1/2024 3:26 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1053373480 (AK)		10/1/2024 3:26 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1053373480 (OR)		10/1/2024 3:26 PM
Contacts	Primary Contact	Update	PC Change Request	Hull, Michael AVP Pharmacy Business Development and Operations Yakima Valley Memorial Hospital 5092495227	Bradshaw, Jake Aaron Director of Pharmacy Yakima Valley Memorial Hospital 5097462002	9/17/2024 11:03 AM
Details	Last Recertification Date	Update	Recertification	9/7/2023 11:59:55 AM	8/17/2024 9:42:21 PM	8/17/2024 9:42 PM
Contacts	Primary Contact	Update	Group Change Request	Hull, Michael Director of Pharmacy Yakima Valley Memorial Hospital 5092495227	Hull, Michael AVP Pharmacy Business Development and Operations Yakima Valley Memorial Hospital 5092495227	7/16/2024 6:42 AM
Contacts	Authorizing Official	Update	AO Change Request	Mitchell, Jason Lee Interim CFO Yakima Valley Memorial Hospital 2063049458	Buyok, Tammy K. President and Market Leader Yakima Valley Memorial Hospital 5095758001	2/15/2024 4:04 PM
Details	Last Recertification Date	Update	Recertification	9/15/2022 4:12:58 PM	9/7/2023 11:59:55 AM	9/7/2023 11:59 AM
Contacts	Authorizing Official	Update	AO Change Request	Haas, Shawnie VP Yakima Valley Memorial Hospital 5095758000	Mitchell, Jason Lee Interim CFO Yakima Valley Memorial Hospital 2063049458	8/7/2023 7:36 AM
Contacts	Authorizing Official	Update	AO Change Request	Sauder, Susan Evelyn CFO Yakima Valley Memorial Hospital Assoc 5092495132	Haas, Shawnie VP Yakima Valley Memorial Hospital 5095758000	1/9/2023 6:22 AM
Details	Last Recertification Date	Update	Recertification	8/31/2021 2:22:44 PM	9/15/2022 4:12:58 PM	9/15/2022 4:12 PM
Contacts	Authorizing Official	Update	Change Request	McDonagh, Thomas M CFO YVMH 5095758980	Sauder, Susan Evelyn CFO Yakima Valley Memorial Hospital Assoc 5092495132	5/18/2022 1:28 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1942300926 (WA)		3/15/2022 1:18 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1568719359 (WA)		3/15/2022 1:18 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1336236272 (WA)		3/15/2022 1:18 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	HS7WAIP (AK)		1/17/2022 5:18 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	1/17/2022 5:18 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1042669	1/17/2022 5:18 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		WA	1/17/2022 5:18 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1053373480 (ID)		8/31/2021 2:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1942300926	8/31/2021 2:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/31/2021 2:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1568719359	8/31/2021 2:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/31/2021 2:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1336236272	8/31/2021 2:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/31/2021 2:22 PM
Details	Last Recertification Date	Update	Recertification	9/4/2020 1:56:59 PM	8/31/2021 2:22:44 PM	8/31/2021 2:22 PM
Contacts	Authorizing Official	Update	AO Change Request	Reed, Timothy CFO Yakima Valley Memorial Hospital 5095745965	McDonagh, Thomas M CFO YVMH 5095758980	7/30/2021 7:05 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 1:56 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HS7WAIP	9/4/2020 1:56 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AK	9/4/2020 1:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 1:56 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		HS7WAOP	9/4/2020 1:56 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AK	9/4/2020 1:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/4/2020 1:56 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		220079	9/4/2020 1:56 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	9/4/2020 1:56 PM
Medicaid Billing	NPI: State	Update	Recertification		WA	9/4/2020 1:56 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1053373480	9/4/2020 1:56 PM
Medicaid Billing	NPI: State	Insert	Recertification		AK	9/4/2020 1:56 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1053373480	9/4/2020 1:56 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/4/2020 1:56 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1053373480	9/4/2020 1:56 PM
Medicaid Billing	NPI: State	Insert	Recertification		ID	9/4/2020 1:56 PM
Details	Last Recertification Date	Update	Recertification	9/13/2019 6:40:42 AM	9/4/2020 1:56:59 PM	9/4/2020 1:56 PM
Addresses	Billing Address	Insert	Recertification		Yakima Valley Memorial Hospital 2811 Tieton Drive Yakima, WA 98902	9/13/2019 6:40 AM
Addresses	Shipping Address	Insert	Recertification		Yakima Valley Memorial Hospital 2811 Tieton Drive Yakima, WA 98902	9/13/2019 6:40 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 4:13:16 PM	9/13/2019 6:40:42 AM	9/13/2019 6:40 AM
Details	Last Recertification Date	Update	Recertification	11/8/2017 7:34:37 PM	8/21/2018 4:13:16 PM	8/21/2018 4:13 PM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	11/8/2017 7:34:37 PM	11/8/2017 7:34 PM
Contacts	Authorizing Official	Update		Reed, Timothy CFO 5095745965	Reed, Timothy CFO Yakima Valley Memorial Hospital 5095745965	10/9/2017 4:39 PM
Contacts	Primary Contact	Update		Hull, Michael Director of Pharmacy 5092495227	Hull, Michael Director of Pharmacy Yakima Valley Memorial Hospital 5092495227	10/9/2017 4:25 PM
Contacts	Primary Contact	Insert			Hull, Michael Director of Pharmacy 5092495227	5/17/2017 3:26 PM
Contacts	Authorizing Official	Insert			Reed, Timothy CFO 5095745965	5/17/2017 3:26 PM
Addresses	Main Address	Insert			3003 Tieton Drive Suite 100 Yakima, WA 98902	5/17/2017 3:26 PM
Contacts	Signed By	Insert			OLANDER, SCOTT CHIEF FINANCIAL OFFICER 5092495201	5/17/2017 3:26 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/23/2016 12:00:00 AM	8/23/2016 5:31 PM
Details	Last Recertification Date	Update		8/14/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 4:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/30/2014 10:23 AM
Medicaid Billing	Medicaid: Number	Insert			3307501	9/30/2014 10:23 AM
Medicaid Billing	Medicaid: State	Insert			WA	9/30/2014 10:23 AM
Medicaid Billing	NPI: Number	Insert			1053373480	9/30/2014 10:23 AM
Details	Last Recertification Date	Update			8/14/2014 12:00:00 AM	8/14/2014 2:56 PM
Dates	Participating Approval Date	Update			12/6/2013 12:00:00 AM	12/6/2013 4:09 PM
Details	State	Update		Pending	Active	12/6/2013 4:09 PM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	12/6/2013 4:09 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH500036D	12/6/2013 3:02 PM
Details	Last Recertification Date	Insert				10/14/2013 5:34 PM
Details	Grant Number	Insert				10/14/2013 5:34 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/14/2013 5:34 PM
Details	Is Authorizing Official EHB Data	Insert				10/14/2013 5:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2013 5:34 PM
Details	Medicare Provider Number	Insert			500036	10/14/2013 5:34 PM
Details	Entity Name	Insert			YAKIMA VALLEY MEMORIAL HOSPITAL	10/14/2013 5:34 PM
Details	Program Code	Insert			DSH	10/14/2013 5:34 PM
Details	Entity Subname	Insert			The Surgi-Center at Memorial	10/14/2013 5:34 PM
Dates	Participating Approval Date	Insert				10/14/2013 5:34 PM
Details	State	Insert			Pending	10/14/2013 5:34 PM
Dates	Registration Date	Insert			10/14/2013 12:00:00 AM	10/14/2013 5:34 PM
Dates	Signed By Date	Insert			10/14/2013 12:00:00 AM	10/14/2013 5:34 PM
Dates	Start Date	Insert				10/14/2013 5:34 PM
Terminations	Termination Comments	Insert				10/14/2013 5:34 PM
Terminations	Termination Date	Insert				10/14/2013 5:34 PM
Terminations	Termination Effective Date	Insert				10/14/2013 5:34 PM
Terminations	Termination Reason	Insert				10/14/2013 5:34 PM