Covered Entity Details

DSH500058E Kadlec Regional Medical Center (Active) - information as of 4/25/2025 9:21:39 PM

Main Details

Name

Kadlec Regional Medical Center

Subdivision Name

OPIC MRI

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH500058E

Medicare Provider Number

500058

Outpatient Facility Provider Number

500058

Additional Details

Current Program Status

Active

Registration Date

7/14/2014

Participating Start Date

10/1/2014

Participating Approval Date

8/29/2014

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

Kadlec Regional Medical Center
Spencer Dwayne Harris, CFO
(509) 942-2708

Primary Contact

Kadlec Regional Medical Center
C.J. Cahoon, Director of Pharmacy
(509) 946-4611 Ext: 4263

Addresses

Street Address

945 Goethals Drive
Richland, WA 99352

Billing Address

Kadlec Regional Medical Center
PO Box 389673
Seattle, WA 98138

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	3311305	1972507580
OR	101766	1972507580

Shipping Addresses

Shipping Address 1

Kadlec Regional Medical Center
888 Swift Boulevard
Attn: Pharmacy Dept
Richland, WA 99352

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
DSH500058A	Child	DSH	Kadlec Regional Medical Center	Kadlec Wound Care Center	Kadlec Wound Care Center.	RICHLAND	WA	Terminated
DSH500058AA	Child	DSH	Kadlec Regional Medical Center	Infectious Disease	833 Swift Blvd	Richland	WA	Active
DSH500058AB	Child	DSH	Kadlec Regional Medical Center	Center for Peds	8108 W. Grandridge Blvd.	Kennewick	WA	Terminated
DSH500058AC	Child	DSH	Kadlec Regional Medical Center	Urology	780 Swift Blvd.	Richland	WA	Active
DSH500058AD	Child	DSH	Kadlec Regional Medical Center	Foot & Ankle	780 Swift Blvd	Richland	WA	Active
DSH500058AE	Child	DSH	Kadlec Regional Medical Center	ENT	780 Swift Blvd	Richland	WA	Active
DSH500058AF	Child	DSH	Kadlec Regional Medical Center	South Richland Primary Care	560 Gage Blvd	Richland	WA	Terminated
DSH500058AG	Child	DSH	Kadlec Regional Medical Center	Senior Clinic - Richland	560 Gage Blvd	Richland	WA	Active
DSH500058AH	Child	DSH	Kadlec Regional Medical Center	West Richland Primary Care	3950 Keene Road	W. Richland	WA	Terminated
DSH500058AJ	Child	DSH	Kadlec Regional Medical Center	Inland Cardiology - Kennewick	3900 S Zintel Way	Kennewick	WA	Active
DSH500058AK	Child	DSH	Kadlec Regional Medical Center	Kennewick Primary Care	3900 S. Zintel Way	Kennewick	WA	Terminated
DSH500058AL	Child	DSH	Kadlec Regional Medical Center	Richland Primary Care	1135 Jadwin Ave.	Richland	WA	Terminated
DSH500058AM	Child	DSH	Kadlec Regional Medical Center	Vascular Surgery	1100 Goethals Dr.	Richland	WA	Active
DSH500058AN	Child	DSH	Kadlec Regional Medical Center	Neurosurgery	1100 Goethals Dr.	Richland	WA	Active
DSH500058AP	Child	DSH	Kadlec Regional Medical Center	Inland Cardiology - Richland	1100 Goethals Dr.	Richland	WA	Active
DSH500058AQ	Child	DSH	Kadlec Regional Medical Center	Nephrology - Kennewick	510 N. Colorado St.	Kennewick	WA	Terminated
DSH500058AR	Child	DSH	Kadlec Regional Medical Center	General Surgery	780 Swift Blvd	Richland	WA	Active
DSH500058AS	Child	DSH	Kadlec Regional Medical Center	Endocrinology	1100 Goethals Dr.	Richland	WA	Active
DSH500058AT	Child	DSH	Kadlec Regional Medical Center	CardioThoracic Surgery	1100 Goethals Dr.	Richland	WA	Active
DSH500058AU	Child	DSH	Kadlec Regional Medical Center	Interventional Radiology	1100 Goethals Dr.	Richland	WA	Terminated
DSH500058AV	Child	DSH	Kadlec Regional Medical Center	KADLEC CLINIC URGENT CARE - Urgent Care	4804W CLEARWATER AVE	KENNEWICK	WA	Terminated
DSH500058AW	Child	DSH	Kadlec Regional Medical Center	KADLEC CLINIC PULMONOLOGY - Pulmonology	1100 GOETHALS DR	RICHLAND	WA	Active
DSH500058AX	Child	DSH	Kadlec Regional Medical Center	KADLEC CLINIC PLASTIC SURGERY & DERMATOLOGY	104 COLUMBIA POINT DR	RICHLAND	WA	Active
DSH500058AY	Child	DSH	Kadlec Regional Medical Center	Family Medicine Residency Clinic - Residency Clinic	940 Northgate Dr	Richland	WA	Active
DSH500058AZ	Child	DSH	Kadlec Regional Medical Center	Pharmacotherapy Clinic - Pharmacotherapy Clinic	1268 Lee Boulevard	Richland	WA	Active
DSH500058B	Child	DSH	Kadlec Regional Medical Center	OPIC Ultrasound	945 Goethals Drive	Richland	WA	Active
DSH500058BA	Child	DSH	Kadlec Regional Medical Center	Kadlec Medical Pain Management - KNC Medication Pain Management	1100 Goethals Dr	Richland	WA	Active
DSH500058C	Child	DSH	Kadlec Regional Medical Center	OPIC Nuclear Medicine	945 Goethals Drive	Richland	WA	Active
DSH500058D	Child	DSH	Kadlec Regional Medical Center	OPIC CT Scan	945 Goethals Drive	Richland	WA	Active
DSH500058E	Child	DSH	Kadlec Regional Medical Center	OPIC MRI	945 Goethals Drive	Richland	WA	Active
DSH500058F	Child	DSH	Kadlec Regional Medical Center	Kadlec Healthplex Respiratory Therapy	1268 Lee Boulevard	Richland	WA	Active
DSH500058G	Child	DSH	Kadlec Regional Medical Center	OPIC Diagnostic Imaging	945 Goethals Drive	Richland	WA	Active
DSH500058H	Child	DSH	Kadlec Regional Medical Center	Kadlec Healthplex Cardiopulmonary Rehab	1268 Lee Boulevard	Richland	WA	Active
DSH500058J	Child	DSH	Kadlec Regional Medical Center	Kadlec Healthplex Anticoagulation	1268 Lee Boulevard	Richland	WA	Active
DSH500058K	Child	DSH	Kadlec Regional Medical Center	Kennewick Freestanding Emergency Department	3290 W 19th Avenue	Kennewick	WA	Active
DSH500058L	Child	DSH	Kadlec Regional Medical Center	Kadlec Healthplex Wound Care	1268 Lee Boulevard	Richland	WA	Active
DSH500058M	Child	DSH	Kadlec Regional Medical Center	KNC Physiatry	1100 Goethals Drive	Richland	WA	Active
DSH500058N	Child	DSH	Kadlec Regional Medical Center	KNC Neurology	1100 Goethals Drive	Richland	WA	Active
DSH500058P	Child	DSH	Kadlec Regional Medical Center	KNC Pain Management	1100 Goethals Drive	Richland	WA	Active
DSH500058Q	Child	DSH	Kadlec Regional Medical Center	Associated Physicians for Women Clinic	945 Goethals Drive	Richland	WA	Terminated
DSH500058R	Child	DSH	Kadlec Regional Medical Center	Kennewick FSED CT	3290 W. 19th Ave.	Kennewick	WA	Active
DSH500058S	Child	DSH	Kadlec Regional Medical Center	OPIC Mammography	945 Goethals Drive	Richland	WA	Active
DSH500058T	Child	DSH	KADLEC REGIONAL MEDICAL CENTER	OP Oncology	888 Swift Boulevard	Richland	WA	Terminated
DSH500058U	Child	DSH	Kadlec Regional Medical Center	Kadlec Clinic Hematology and Oncology	7360 W. Deschutes Ave	Kennewick	WA	Active
DSH500058V	Child	DSH	KADLEC REGIONAL MEDICAL CENTER	Associated Physicians for Women Clinic – Satellite	112 Columbia Point Dr., Ste. 101	Richland	WA	Terminated
DSH500058W	Child	DSH	Kadlec Regional Medical Center	KADLEC CLINIC RHEUMATOLOGY	6710 W OKANOGAN PL	KENNEWICK	WA	Active
DSH500058X	Child	DSH	Kadlec Regional Medical Center	Urgent Care - Pasco	9605 Sandifur Parkway	Pasco	WA	Terminated
DSH500058Y	Child	DSH	Kadlec Regional Medical Center	Pasco Primary Care	9605 Sandifur Parkway	Pasco	WA	Terminated
DSH500058Z	Child	DSH	Kadlec Regional Medical Center	Pasco Behavioral Health	9605 Sandifur Parkway	Pasco	WA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/19/2023 2:10:50 PM	8/23/2024 7:17:07 PM	8/23/2024 7:17 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 12:31:11 PM	8/19/2023 2:10:50 PM	8/19/2023 2:10 PM
Details	Last Recertification Date	Update	Recertification	9/8/2021 11:54:07 PM	9/14/2022 12:31:11 PM	9/14/2022 12:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/8/2021 11:54 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		101766	9/8/2021 11:54 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	9/8/2021 11:54 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1972507580	9/8/2021 11:54 PM
Medicaid Billing	NPI: State	Insert	Recertification		OR	9/8/2021 11:54 PM
Details	Last Recertification Date	Update	Recertification	9/8/2020 8:56:19 PM	9/8/2021 11:54:07 PM	9/8/2021 11:54 PM
Addresses	Billing Address	Update	Change Request	Kadlec Regional Medical Center 888 Swift Boulevard Attn: Pharmacy Dept Richland, WA 99352	Kadlec Regional Medical Center PO Box 389673 Seattle, WA 98138	2/6/2021 12:18 PM
Medicaid Billing	NPI: State	Update	Recertification		WA	9/8/2020 8:56 PM
Details	Last Recertification Date	Update	Recertification	9/4/2019 7:37:38 PM	9/8/2020 8:56:19 PM	9/8/2020 8:56 PM
Details	Last Recertification Date	Update	Recertification	8/18/2018 1:31:34 PM	9/4/2019 7:37:38 PM	9/4/2019 7:37 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 12:37:18 AM	8/18/2018 1:31:34 PM	8/18/2018 1:31 PM
Contacts	Primary Contact	Update	Change Request	Ovenell, Mac Powell 340B & Pharmacy Purchasing Supervisor Kadlec Regional Medical Center 5099422582	Cahoon, C.J. Director of Pharmacy Kadlec Regional Medical Center 5099464611-4263	4/24/2018 10:57 PM
Contacts	Primary Contact	Update	Change Request	Cahoon, C.J. Director of Pharmacy Kadlec Regional Medical Center 5099464611-4263	Ovenell, Mac Powell 340B & Pharmacy Purchasing Supervisor Kadlec Regional Medical Center 5099422582	4/13/2018 8:30 PM
Details	Last Recertification Date	Update	Recertification	8/17/2016 12:00:00 AM	11/10/2017 12:37:18 AM	11/10/2017 12:37 AM
Contacts	Authorizing Official	Insert	AO Change Request		Harris, Spencer Dwayne CFO Kadlec Regional Medical Center 5099422708	10/24/2017 6:20 AM
Contacts	Signed By	Update	New Registration	SAVITCH, LANE PRESIDENT 5099464611-2709	SAVITCH, LANE PRESIDENT Kadlec Regional Medical Center 5099464611-2709	10/13/2017 5:49 PM
Contacts	Primary Contact	Update		Cahoon, C.J. Director of Pharmacy 5099464611-4263	Cahoon, C.J. Director of Pharmacy Kadlec Regional Medical Center 5099464611-4263	9/19/2017 4:06 PM
Contacts	Signed By	Insert			SAVITCH, LANE PRESIDENT 5099464611-2709	7/24/2017 5:05 PM
Contacts	Primary Contact	Update		Pearson, David Pharmacy Director 5099464611-4263	Cahoon, C.J. Director of Pharmacy 5099464611-4263	7/24/2017 5:05 PM
Addresses	Main Address	Insert			945 Goethals Drive Richland, WA 99352	7/24/2017 5:05 PM
Addresses	Billing Address	Insert			Kadlec Regional Medical Center 888 Swift Boulevard Attn: Pharmacy Dept Richland, WA 99352	7/24/2017 5:05 PM
Addresses	Shipping Address	Insert			Kadlec Regional Medical Center 888 Swift Boulevard Attn: Pharmacy Dept Richland, WA 99352	7/24/2017 5:05 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/17/2016 12:00:00 AM	8/19/2016 2:53 PM
Contacts	Primary Contact	Insert			Pearson, David Pharmacy Director 5099464611-4263	8/6/2015 9:04 AM
Details	Last Recertification Date	Update			8/5/2015 12:00:00 AM	8/5/2015 4:09 PM
Medicaid Billing	NPI: Number	Insert			1972507580	3/16/2015 11:20 AM
Details	Entity Subname	Update		OPIC MRI / MRI	OPIC MRI	12/31/2014 3:51 PM
Details	Entity Subname	Update		OPIC MRI	OPIC MRI / MRI	12/19/2014 2:16 PM
Dates	Participating Approval Date	Update			8/29/2014 12:00:00 AM	8/29/2014 1:20 PM
Details	State	Update		Pending	Active	8/29/2014 1:20 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	8/29/2014 1:20 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_45657	DSH500058E	8/25/2014 9:15 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_45657	7/14/2014 4:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/14/2014 4:44 PM
Medicaid Billing	Medicaid: Number	Insert			3311305	7/14/2014 4:44 PM
Medicaid Billing	Medicaid: State	Insert			WA	7/14/2014 4:44 PM
Details	Last Recertification Date	Insert				7/14/2014 4:44 PM
Details	Grant Number	Insert				7/14/2014 4:44 PM
Details	340B ID	Insert				7/14/2014 4:44 PM
Details	Is Authorizing Official EHB Data	Insert				7/14/2014 4:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/14/2014 4:44 PM
Details	Medicare Provider Number	Insert			500058	7/14/2014 4:44 PM
Details	Entity Name	Insert			Kadlec Regional Medical Center	7/14/2014 4:44 PM
Details	Program Code	Insert			DSH	7/14/2014 4:44 PM
Details	Entity Subname	Insert			OPIC MRI	7/14/2014 4:44 PM
Dates	Participating Approval Date	Insert				7/14/2014 4:44 PM
Details	State	Insert			Pending	7/14/2014 4:44 PM
Dates	Registration Date	Insert			7/14/2014 12:00:00 AM	7/14/2014 4:44 PM
Dates	Signed By Date	Insert			7/14/2014 12:00:00 AM	7/14/2014 4:44 PM
Dates	Start Date	Insert				7/14/2014 4:44 PM
Terminations	Termination Comments	Insert				7/14/2014 4:44 PM
Terminations	Termination Date	Insert				7/14/2014 4:44 PM
Terminations	Termination Effective Date	Insert				7/14/2014 4:44 PM
Terminations	Termination Reason	Insert				7/14/2014 4:44 PM