Covered Entity Details

DSH500053P KENNEWICK GENERAL HOSPITAL (Terminated) - information as of 5/17/2025 10:56:27 PM

Main Details

Name

KENNEWICK GENERAL HOSPITAL

Subdivision Name

KGH Medical Group Pediatrics

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500053P

Medicare Provider Number

500053

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/10/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/4/2014

Last Recertification Date

12/6/2017

Termination Date
Termination Reason

10/1/2018
For-Profit conversion

Contacts

Authorizing Official

RCCH Trios Health, LLC
Jason Hotchkiss, CFO
(509) 221-5735

Primary Contact

Kennewick Public Hospital District
MICHAEL Robert-Reece PORTER, DIRECTOR OF PHARMACY
(509) 221-5788

Addresses

Street Address

320 W. 10th Ave., Suite 100
Kennewick, WA 99336

Billing Address

KGH Medical Group
900 S Auburn St
Kennewick, WA 99336

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?
No

Shipping Addresses

Shipping Address 1

KGH Medical Group
900 S Auburn St
Kennewick, WA 99336

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
DSH500053A	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Emergency Services	KGH Trios Southridge	Kennewick	WA	Terminated
DSH500053AA	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH MID COLUMBIA WOMEN'S HLTH CNTR	320 W 10TH AVE	KENNEWICK	WA	Terminated
DSH500053AB	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH KID'S CARE	7211 DESCHUTES	KENNEWICK	WA	Terminated
DSH500053AC	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH WALK-IN CARE	4303 W 27TH AVE	KENNEWICK	WA	Terminated
DSH500053AD	Child	DSH	KENNEWICK GENERAL HOSPITAL	KENNEWICK PUBLIC HOPSITAL DISTRIACT / After Hours Pediatric Care	7201 W GRANDRIDGE BLVD #100	KENNEWICK	WA	Terminated
DSH500053AE	Child	DSH	KENNEWICK GENERAL HOSPITAL	Trios Urgent Care Center / Columbia Center	7201 W GRANDRIDGE STE 100	KENNEWICK	WA	Terminated
DSH500053AF	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH / Cardiology	216 W 10TH AVE #302	KENNEWICK	WA	Terminated
DSH500053AG	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH GENERAL SURGERY	216 W 10TH AVE #202	KENNEWICK	WA	Terminated
DSH500053AH	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group-Psychiatry	KGH Medical Group - Psychiatry	Kennewick	WA	Terminated
DSH500053AJ	Child	DSH	KENNEWICK GENERAL HOSPITAL	TRIOS HEALTH CENTER AT SOUTHRIDGE	3730 PLAZA WAY	KENNEWICK	WA	Terminated
DSH500053B	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group / KGH Adult Hospitalist	KGH Medical Group Southridge Hosptalist	Kennewick	WA	Terminated
DSH500053C	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group / KGH Pediatric Hospitalist	900 S Auburn St	Kennewick	WA	Terminated
DSH500053D	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGh Medical Group	KGH Medical Group at Evergreen	Kennewick	WA	Terminated
DSH500053E	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group / Sleep Center	8232 W. Grandridge Blvd	Kennewick	WA	Terminated
DSH500053F	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group / KGH Medical Group - Pulmonology	KGH Medical Group - Pulmonology	Kennewick	WA	Terminated
DSH500053G	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group / Infectious Disease	KGH Medical Group - Infectious Disease	Kennewick	WA	Terminated
DSH500053H	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group / Cynergy Family Medicine	KGH Medical Group - Cynergy Family Medicine	Kennewick	WA	Terminated
DSH500053J	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group / Pediatrics	KGH - Pediatrics	Kennewick	WA	Terminated
DSH500053K	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Central Kennewick - Urgent Care	KGH Medical Group - Central Kennewick Urgent Care	Kennewick	WA	Terminated
DSH500053L	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group	KGH - Geriatircs	Kennewick	WA	Terminated
DSH500053M	Child	DSH	KENNEWICK GENERAL HOSPITAL	KENNEWICK PUBLIC HOSPITAL DISTRICT / KGH Urgent Care at Auburn	900 S AUBURN	KENNEWICK	WA	Terminated
DSH500053N	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH - Cardiology	4309 W 27th Place, Suite 301	Kennewick	WA	Terminated
DSH500053P	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group Pediatrics	320 W. 10th Ave., Suite 100	Kennewick	WA	Terminated
DSH500053Q	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Surgical	216 W 10TH AVE STE 204	KENNEWICK	WA	Terminated
DSH500053R	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH/ DR. 'G'S' PEDIATRICS	320 W 10TH AVE STE 202A	KENNEWICK	WA	Terminated
DSH500053S	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH COLUMBIA FAMILY MEDICINE	320 W 10TH AVE #202	KENNEWICK	WA	Terminated
DSH500053T	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH Medical Group	521 N YOUNG ST	KENNEWICK	WA	Terminated
DSH500053U	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH HADDADIN	216 W 10TH AVE	KENNEWICK	WA	Terminated
DSH500053V	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH GASTROENTEROLOGY	7211 DESCHUTES	KENNEWICK	WA	Terminated
DSH500053W	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH FAMILY PRACTICE	216 W 10TH AVE	KENNEWICK	WA	Terminated
DSH500053X	Child	DSH	KENNEWICK GENERAL HOSPITAL	KENNEWICK PUBLIC HOSPITAL DISTRICT	83 KEENE RD	RICHLAND	WA	Terminated
DSH500053Y	Child	DSH	KENNEWICK GENERAL HOSPITAL	KENNEWICK PUBLIC HOSPITAL DISTRICT / Internal Medicine	320 W 10TH AVE STE 200	KENNEWICK	WA	Terminated
DSH500053Z	Child	DSH	KENNEWICK GENERAL HOSPITAL	KGH WALK IN CARE	81 KEENE RD	RICHLAND	WA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2018 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		8/3/2018 12:00:00 AM	8/20/2018 2:04 PM
Details	State	Update	Termination Request	Active	To Be Terminated	8/20/2018 2:04 PM
Terminations	Termination Comments	Update	Termination Request		Converted to a For-Profit entity as of August 4, 2018. Please terminate the Parent and all Child accounts. JH 8/8/2018	8/20/2018 2:04 PM
Terminations	Termination Date	Update	Termination Request		10/1/2018 12:00:00 AM	8/20/2018 2:04 PM
Terminations	Termination Effective Date	Update	Termination Request		8/4/2018 12:00:00 AM	8/20/2018 2:04 PM
Terminations	Termination Reason	Update	Termination Request		For-Profit conversion	8/20/2018 2:04 PM
Contacts	Authorizing Official	Update	AO Change Request	Sudduth, Tony CFO Kennewick Public Hospital District 5092215349	Hotchkiss, Jason CFO RCCH Trios Health, LLC 5092215735	8/6/2018 7:21 AM
Contacts	Primary Contact	Update		PORTER, MICHAEL DIRECTOR OF PHARMACY Kennewick Public Hospital District 5092215788	PORTER, MICHAEL Robert-Reece DIRECTOR OF PHARMACY Kennewick Public Hospital District 5092215788	12/12/2017 4:43 PM
Contacts	Primary Contact	Update	Recertification	Sudduth, Tony CFO Kennewick Public Hospital District 5092215349	PORTER, MICHAEL DIRECTOR OF PHARMACY Kennewick Public Hospital District 5092215788	12/6/2017 1:14 PM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	12/6/2017 1:14:04 PM	12/6/2017 1:14 PM
Contacts	Authorizing Official	Update		Sudduth, Tony CFO 5092215349	Sudduth, Tony CFO Kennewick Public Hospital District 5092215349	10/26/2017 12:41 PM
Contacts	Primary Contact	Update		Sudduth, Tony CFO 5092215349	Sudduth, Tony CFO Kennewick Public Hospital District 5092215349	10/26/2017 12:41 PM
Contacts	Signed By	Update		Sudduth, Tony CFO 5092215349	Sudduth, Tony CFO Kennewick Public Hospital District 5092215349	10/26/2017 12:41 PM
Contacts	Authorizing Official	Insert			Sudduth, Tony CFO 5092215349	4/17/2017 6:33 PM
Contacts	Primary Contact	Insert			Sudduth, Tony CFO 5092215349	4/17/2017 6:33 PM
Contacts	Signed By	Insert			Sudduth, Tony CFO 5092215349	4/17/2017 6:33 PM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 3:07 PM
Addresses	Main Address	Insert			320 W. 10th Ave., Suite 100 Kennewick, WA 99336	8/11/2016 3:07 PM
Addresses	Billing Address	Insert			KGH Medical Group 900 S Auburn St Kennewick, WA 99336	5/11/2016 1:27 PM
Addresses	Shipping Address	Insert			KGH Medical Group 900 S Auburn St Kennewick, WA 99336	5/11/2016 1:27 PM
Details	Last Recertification Date	Update			8/25/2015 12:00:00 AM	8/25/2015 10:26 AM
Dates	Participating Approval Date	Update			12/4/2014 12:00:00 AM	12/4/2014 11:13 AM
Details	State	Update		Pending	Active	12/4/2014 11:13 AM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/4/2014 11:13 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_46983	DSH500053P	11/5/2014 11:18 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_46983	10/10/2014 11:41 AM
Details	Last Recertification Date	Insert				10/10/2014 11:41 AM
Details	Grant Number	Insert				10/10/2014 11:41 AM
Details	340B ID	Insert				10/10/2014 11:41 AM
Details	Is Authorizing Official EHB Data	Insert				10/10/2014 11:41 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/10/2014 11:41 AM
Details	Medicare Provider Number	Insert			500053	10/10/2014 11:41 AM
Details	Entity Name	Insert			KENNEWICK GENERAL HOSPITAL	10/10/2014 11:41 AM
Details	Program Code	Insert			DSH	10/10/2014 11:41 AM
Details	Entity Subname	Insert			KGH Medical Group Pediatrics	10/10/2014 11:41 AM
Dates	Participating Approval Date	Insert				10/10/2014 11:41 AM
Details	State	Insert			Pending	10/10/2014 11:41 AM
Dates	Registration Date	Insert			10/10/2014 12:00:00 AM	10/10/2014 11:41 AM
Dates	Signed By Date	Insert			10/10/2014 12:00:00 AM	10/10/2014 11:41 AM
Dates	Start Date	Insert				10/10/2014 11:41 AM
Terminations	Termination Comments	Insert				10/10/2014 11:41 AM
Terminations	Termination Date	Insert				10/10/2014 11:41 AM
Terminations	Termination Effective Date	Insert				10/10/2014 11:41 AM
Terminations	Termination Reason	Insert				10/10/2014 11:41 AM