Covered Entity Details

DSH500003M SKAGIT VALLEY HOSPITAL (Active) - information as of 4/23/2025 10:51:17 PM

Main Details

Name

SKAGIT VALLEY HOSPITAL

Subdivision Name

Skagit Regional Clinics Riverbend Dermatology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500003M

Medicare Provider Number

500003

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

5/23/2014

Participating Start Date

7/1/2014

Participating Approval Date

5/29/2014

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Public Hospital District No. 1, Skagit County, dba Skagit Regional Health
Tamara L Cesena, Chief Financial Officer
(360) 445-8512

Primary Contact

Skagit Valley Hospital
Alma K Martinez, 340B Program Manager
(360) 814-5001

Addresses

Street Address

2320 FREEWAY DRIVE
MOUNT VERNON, WA 98274-4126

Billing Address

Skagit Regional Health
PO Box 1376
Mount Vernon, WA 98273

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	3323300	1023332749,1053357244

Shipping Addresses

Shipping Address 1

SKAGIT REGIONAL CLINICS RIVERBEND DERMATOLOGY
2320 FREEWAY DRIVE
(URGENT CARE)
MOUNT VERNON, WA 98273

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
DSH500003A	Child	DSH	SKAGIT VALLEY HOSPITAL	Camano Community Health Clinic	127 N EAST CAMANO DRIVE	CAMANO ISLAND	WA	Active
DSH500003AA	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon -Sleep Medicine	1400 East Kincaid St	Mount Vernon	WA	Terminated
DSH500003AB	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Riverbend -Rheumatology	2320 Freeway Drive	Mount Vernon	WA	Active
DSH500003AC	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center Podiatry	211 S. 13th St.	Mount Vernon	WA	Active
DSH500003AD	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon-Pulmonary	1400 East Kincaid St	Mount Vernon	WA	Terminated
DSH500003AE	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon-Plastic Surgery	1400 East Kincaid St	Mount Vernon	WA	Active
DSH500003AF	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Cliniic Cascade Skagit Health Alliance-Pediatrics	3823 172nd St NE	Arlington	WA	Terminated
DSH500003AG	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center Interventional Pain Medicine	211 S. 13th St.	Mount Vernon	WA	Active
DSH500003AH	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon-Optometry	1400 East Kincaid St	Mount Vernon	WA	Terminated
DSH500003AJ	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Sedro Woolley-Optometry	1990 Hospital Dr Suite 200	Sedro Woolley	WA	Terminated
DSH500003AK	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point-Occupational Medicine	3823 172nd St NE	Arlington	WA	Terminated
DSH500003AL	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon-Occupational Medicine	1400 East Kincaid St	Mount Vernon	WA	Terminated
DSH500003AM	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon-Neurosurgery	1400 East Kincaid St	Mount Vernon	WA	Terminated
DSH500003AN	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinic Cascade Skagit Health Alliance -Internal Medicine	3823 172nd St Ne	Arlington	WA	Terminated
DSH500003AP	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Sedro Woolley-Internal Medicine	1990 Hospital Drive Suite 200	Sedro Woolley	WA	Terminated
DSH500003AQ	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Stanwood-Internal Medicine	9631 269th St. NW	Stanwood	WA	Terminated
DSH500003AR	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinic Cascade Skagit Health Alliance-Family Medicine	3823 172nd St NE	Arlington	WA	Terminated
DSH500003AS	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clincs Stanwood-Family Medicine	9631 269th St NW	Stanwood	WA	Active
DSH500003AT	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon-Internal Medicine	1400 East Kincaid St	Mount Vernon	WA	Terminated
DSH500003AU	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center Gastroenterology	211 S. 13th St.	Mount Vernon	WA	Active
DSH500003AV	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon-Family Medicine	1400 East Kincaid St	Mount Vernon	WA	Active
DSH500003AW	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Sedro Woolley Family Medicine	1990 HOSPITAL DR Suite 100	SEDRO WOOLLEY	WA	Terminated
DSH500003AX	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Infectious Disease	1400 East Kincaid	Mount Vernon	WA	Active
DSH500003AY	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Riverbend Endocrinology	2320 Freeway Drive	Mount Vernon	WA	Active
DSH500003AZ	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics - Mount Vernon Nephrology	1400 East Kincaid Street	Mount Vernon	WA	Active
DSH500003B	Child	DSH	SKAGIT VALLEY HOSPITAL	SKAGIT VALLEY KIDNEY CENTER	208 HOSPITAL PARKWAY	MOUNT VERNON	WA	Terminated
DSH500003BA	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics - Benson Medical Group Family Medicine	110 N Laventure Rd, Suite C	Mount Vernon	WA	Terminated
DSH500003BB	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point Orthopedics	3823 172nd St NE	Arlington	WA	Active
DSH500003BC	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point Dermatology	3823 172nd St NE	Arlington	WA	Active
DSH500003BD	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point Family Medicine	3823 172nd St NE	Arlington	WA	Active
DSH500003BE	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point Rheumatology	3823 172nd St NE	Arlington	WA	Active
DSH500003BF	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point Endocrinology	3823 172nd St NE	Arlington	WA	Active
DSH500003BG	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point Podiatry	3823 172nd St NE	Arlington	WA	Active
DSH500003BH	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point Neurology	3823 172nd St NE	Arlington	WA	Terminated
DSH500003BJ	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Health - Radiation Therapy	307 S 13th St, Suite 100	Mount Vernon	WA	Active
DSH500003BK	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics - Stanwood Orthopedics	9631 269th St NW	Stanwood	WA	Active
DSH500003BL	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics - Mount Vernon Psychiatry	819 S 13th St	Mount Vernon	WA	Active
DSH500003BM	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics - Stanwood Podiatry	9631 269th St NW	Stanwood	WA	Active
DSH500003BN	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center - Anesthesia	211 S 13th St	Mount Vernon	WA	Active
DSH500003BP	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center - Endoscopy	211 S 13th St	Mount Vernon	WA	Active
DSH500003BQ	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center - ENT	211 S. 13th St.	Mount Vernon	WA	Active
DSH500003BR	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center - Operating Room	211 S 13th St	Mount Vernon	WA	Active
DSH500003BS	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center - Post Op	211 S 13th St	Mount Vernon	WA	Active
DSH500003BT	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics - Mount Vernon Midwifery	1400 East Kincaid St	Mount Vernon	WA	Active
DSH500003BU	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics - Station Square Family Medicine	901 S 5th St	Mount Vernon	WA	Active
DSH500003BV	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Health - Pet Scan	307 S 13th St Suite 100	Mount Vernon	WA	Active
DSH500003C	Child	DSH	SKAGIT VALLEY HOSPITAL	Regional Cancer Care Center at Skagit	307 S 13th St, Suite 100	MOUNT VERNON	WA	Active
DSH500003D	Child	DSH	SKAGIT VALLEY HOSPITAL	Regional Cancer Care Center at Smokey Point	3823 172nd St N.E	ARLINGTON	WA	Active
DSH500003H	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinic Cardiology	307 S 13th Street Suite 300	Mount Vernon	WA	Active
DSH500003L	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Residency Family Medicine	819 S 13th St	Mount Vernon	WA	Active
DSH500003M	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Riverbend Dermatology	2320 FREEWAY DRIVE	MOUNT VERNON	WA	Active
DSH500003N	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Riverbend Pediatrics	2320 FREEWAY DR	MOUNT VERNON	WA	Active
DSH500003P	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Riverbend Urgent Care	2320 FREEWAY DR	MOUNT VERNON	WA	Active
DSH500003Q	Child	DSH	SKAGIT VALLEY HOSPITAL	Mount Vernon Surgery Center Orthopedics and Sports Medicine	211 S. 13th St.	MOUNT VERNON	WA	Active
DSH500003R	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Valley Wound Healing Center	208 Hospital Parkway	Mount Vernon	WA	Active
DSH500003S	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon Neurology	1400 East Kincaid St	Mount Vernon	WA	Active
DSH500003T	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Urology	1400 East Kincaid Street	Mount Vernon	WA	Active
DSH500003U	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinic Cascade Skagit Health Alliance-Women's Health	3823 172nd St NE	Arlington	WA	Terminated
DSH500003V	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon -Women's Health	1400 East Kincaid St	Mount Vernon	WA	Active
DSH500003W	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Smokey Point-Urgent Care	3823 172nd St NE	Arlington	WA	Active
DSH500003X	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Station Square -Urgent Care	901 S 5th St	Mount Vernon	WA	Active
DSH500003Y	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Sedro Woolley -Surgery	1990 Hospital Dr Suite 200	Sedro Woolley	WA	Terminated
DSH500003Z	Child	DSH	SKAGIT VALLEY HOSPITAL	Skagit Regional Clinics Mount Vernon -Surgery	1400 East Kincaid St	Mount Vernon	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/24/2023 12:20:55 PM	8/12/2024 12:39:38 PM	8/12/2024 12:39 PM
Addresses	Billing Address	Insert	Change Request		Skagit Regional Health PO Box 1376 Mount Vernon, WA 98273	7/16/2024 4:57 PM
Contacts	Primary Contact	Update	Group Change Request	Martinez, Alma 340B Program Manager Skagit Valley Hospital. 3608145001	Martinez, Alma K 340B Program Manager Skagit Valley Hospital 3608145001	6/24/2024 1:12 PM
Contacts	Primary Contact	Update	Profile Change Request	Martinez, Alma 340B Coordinator Skagit Valley Hospital. 3608145001	Martinez, Alma 340B Program Manager Skagit Valley Hospital. 3608145001	3/27/2024 1:27 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 7:26:56 PM	8/24/2023 12:20:55 PM	8/24/2023 12:20 PM
Contacts	Authorizing Official	Update	AO Change Request	Ishizuka, Paul CFO Skagit Valley Hospital 3608145838	Cesena, Tamara L Chief Financial Officer Public Hospital District No. 1, Skagit County, dba Skagit Regional Health 3604458512	6/1/2023 11:56 AM
Details	Last Recertification Date	Update	Recertification	8/26/2021 11:50:53 AM	9/8/2022 7:26:56 PM	9/8/2022 7:26 PM
Details	Last Recertification Date	Update	Recertification	9/8/2020 7:27:48 PM	8/26/2021 11:50:53 AM	8/26/2021 11:50 AM
Medicaid Billing	NPI: State	Update	Recertification		WA	9/8/2020 7:27 PM
Medicaid Billing	NPI: State	Update	Recertification		WA	9/8/2020 7:27 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 6:45:15 PM	9/8/2020 7:27:48 PM	9/8/2020 7:27 PM
Details	Last Recertification Date	Update	Recertification	8/27/2018 12:18:15 PM	9/5/2019 6:45:15 PM	9/5/2019 6:45 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1001267 (WA)		10/31/2018 10:40 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	2007916 (WA)		10/31/2018 10:40 AM
Details	Last Recertification Date	Update	Recertification	11/9/2017 2:56:58 PM	8/27/2018 12:18:15 PM	8/27/2018 12:18 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1053357244	6/1/2018 12:48 PM
Contacts	Authorizing Official	Update	Change Request	LITAKER, THOMAS CFO 500003 3604458505	Ishizuka, Paul CFO Skagit Valley Hospital 3608145838	1/17/2018 7:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	11/9/2017 2:56 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1001267	11/9/2017 2:56 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	11/9/2017 2:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	11/9/2017 2:56 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		2007916	11/9/2017 2:56 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WA	11/9/2017 2:56 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1700969847 ( )		11/9/2017 2:56 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1831131135 ( )		11/9/2017 2:56 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1023332749	11/9/2017 2:56 PM
Details	Last Recertification Date	Update	Recertification	8/24/2016 12:00:00 AM	11/9/2017 2:56:58 PM	11/9/2017 2:56 PM
Details	Entity Subname	Update	Recertification	SKAGIT REGIONAL CLINICS RIVERBEND DERMATOLOGY	Skagit Regional Clinics Riverbend Dermatology	11/9/2017 2:56 PM
Contacts	Authorizing Official	Update		LITAKER, THOMAS CFO 3604458505	LITAKER, THOMAS CFO 500003 3604458505	9/28/2017 4:22 PM
Contacts	Signed By	Update		LITAKER, THOMAS CFO 3604458505	LITAKER, THOMAS CFO 500003 3604458505	9/28/2017 4:22 PM
Contacts	Primary Contact	Update		Martinez, Alma 340B Coordinator 3608145001	Martinez, Alma 340B Coordinator Skagit Valley Hospital. 3608145001	9/18/2017 4:43 PM
Contacts	Authorizing Official	Insert			LITAKER, THOMAS CFO 3604458505	7/18/2017 6:50 PM
Contacts	Signed By	Insert			LITAKER, THOMAS CFO 3604458505	7/18/2017 6:50 PM
Contacts	Primary Contact	Update		Lai, Cindy Interim Director of Pharmacy 3608142425	Martinez, Alma 340B Coordinator 3608145001	7/12/2017 2:35 PM
Addresses	Main Address	Insert			2320 FREEWAY DRIVE MOUNT VERNON, WA 98274-4126	7/12/2017 2:34 PM
Addresses	Shipping Address	Insert			SKAGIT REGIONAL CLINICS RIVERBEND DERMATOLOGY 2320 FREEWAY DRIVE (URGENT CARE) MOUNT VERNON, WA 98273	7/12/2017 2:34 PM
Details	Last Recertification Date	Update		8/24/2015 12:00:00 AM	8/24/2016 12:00:00 AM	8/24/2016 1:44 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/26/2015 2:45 PM
Details	Last Recertification Date	Update		8/21/2014 12:00:00 AM	8/24/2015 12:00:00 AM	8/26/2015 2:45 PM
Details	Last Recertification Date	Update			8/21/2014 12:00:00 AM	8/21/2014 1:25 PM
Contacts	Primary Contact	Insert			Lai, Cindy Interim Director of Pharmacy 3608142425	7/22/2014 4:50 PM
Dates	Participating Approval Date	Update			5/29/2014 12:00:00 AM	5/29/2014 10:58 AM
Details	State	Update		Pending	Active	5/29/2014 10:58 AM
Dates	Start Date	Update			7/1/2014 12:00:00 AM	5/29/2014 10:58 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH500003M	5/27/2014 10:14 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	5/23/2014 3:47 PM
Medicaid Billing	Medicaid: Number	Insert			3323300	5/23/2014 3:47 PM
Medicaid Billing	Medicaid: State	Insert			WA	5/23/2014 3:47 PM
Medicaid Billing	NPI: Number	Insert			1700969847	5/23/2014 3:47 PM
Medicaid Billing	NPI: Number	Insert			1831131135	5/23/2014 3:47 PM
Details	Last Recertification Date	Insert				5/23/2014 3:47 PM
Details	Grant Number	Insert				5/23/2014 3:47 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	5/23/2014 3:47 PM
Details	Is Authorizing Official EHB Data	Insert				5/23/2014 3:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/23/2014 3:47 PM
Details	Medicare Provider Number	Insert			500003	5/23/2014 3:47 PM
Details	Entity Name	Insert			SKAGIT VALLEY HOSPITAL	5/23/2014 3:47 PM
Details	Program Code	Insert			DSH	5/23/2014 3:47 PM
Details	Entity Subname	Insert			SKAGIT REGIONAL CLINICS RIVERBEND DERMATOLOGY	5/23/2014 3:47 PM
Dates	Participating Approval Date	Insert				5/23/2014 3:47 PM
Details	State	Insert			Pending	5/23/2014 3:47 PM
Dates	Registration Date	Insert			5/23/2014 12:00:00 AM	5/23/2014 3:47 PM
Dates	Signed By Date	Insert			5/23/2014 12:00:00 AM	5/23/2014 3:47 PM
Dates	Start Date	Insert				5/23/2014 3:47 PM
Terminations	Termination Comments	Insert				5/23/2014 3:47 PM
Terminations	Termination Date	Insert				5/23/2014 3:47 PM
Terminations	Termination Effective Date	Insert				5/23/2014 3:47 PM
Terminations	Termination Reason	Insert				5/23/2014 3:47 PM