Covered Entity Details

SCH500033-03 SAMARITAN HEALTHCARE (Active) - information as of 5/25/2025 1:18:26 AM

Main Details

Name

SAMARITAN HEALTHCARE

Subdivision Name

Samaritan Healthcare - Family Medicine

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH500033-03

Medicare Provider Number

500033

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/13/2021

Participating Start Date

7/1/2021

Participating Approval Date

4/29/2021

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Samaritan Healthcare
Alexander Town, Chief Financial Officer
(509) 793-9710

Primary Contact

Samaritan Healthcare
Teresa Gall, Senior Accountant
(509) 765-5606

Addresses

Street Address

1550 S Pioneer Way STE 150/165
Moses Lake, WA 98837

Billing Address
Same as Street Address

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

Samaritan Hospital
801 E Wheeler Rd
Moses Lake, WA 98837

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
SCH500033-01	Child	SCH	SAMARITAN HOSPITAL	SAMARITAN HOSPITAL - Primary Care	1550 S PIONEER WAY	MOSES LAKE	WA	Terminated
SCH500033-02	Child	SCH	SAMARITAN HEALTHCARE	SAMARITAN Healthcare - Adult & Internal Medicine	1550 S Pioneer Way STE 150	Moses Lake	WA	Active
SCH500033-03	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Family Medicine	1550 S Pioneer Way STE 150/165	Moses Lake	WA	Active
SCH500033-04	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Women's Health OB/Gyn	1550 S Pioneer Way STE 370	Moses Lake	WA	Active
SCH500033-05	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - CareToday	1550 S Pioneer Way STE 100	Moses Lake	WA	Active
SCH500033-06	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Podiatry	1550 S Pioneer Way STE 300	Moses Lake	WA	Active
SCH500033-07	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Orthopaedics	1550 S Pioneer Way Ste 350	Moses Lake	WA	Active
SCH500033-08	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Behavioral and Mental Health	1550 S Pioneer Way STE 165	Moses Lake	WA	Active
SCH500033-09	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Pediatrics	1550 S Pioneer Way STE 200	Moses Lake	WA	Active
SCH500033-10	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Gastroenterology - Gastroenterology	1550 S Pioneer Way STE 250	Moses Lake	WA	Active
SCH500033-11	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Patton Clinic - CareToday	8420 ASPI BLVD STE DC	MOSES LAKE	WA	Active
SCH500033-12	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Patton Clinic - Family Medicine	8420 ASPI BLVD STE AB	MOSES LAKE	WA	Active
SCH500033-13	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Urology	1550 S PIONEER WAY STE 205	MOSES LAKE	WA	Active
SCH500033-14	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Pain Management	1550 S PIONEER WAY STE 225	MOSES LAKE	WA	Active
SCH500033-15	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - Cardiology	1550 S Pioneer Way STE 365	Moses Lake	WA	Active
SCH500033-16	Child	SCH	SAMARITAN HEALTHCARE	Samaritan Healthcare - General Surgery	1550 S Pioneer Way STE 305	Moses Lake	WA	Active
SCH500033-17	Child	SCH	SAMARITAN HOSPITAL	Samaritan Hospital - Occupational Medicine - Occupational Medicine	8420 Aspi Blvd.	North Moses Lake	WA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 4:53:06 PM	8/15/2024 1:26:18 PM	8/15/2024 1:26 PM
Contacts	Primary Contact	Update	Change Request	Niehenke, Adam J Controller Samaritan Healthcare 5097939716	Gall, Teresa Senior Accountant Samaritan Healthcare 5097655606	2/15/2024 11:27 AM
Details	Entity Name	Update	Change Request	SAMARITAN HOSPITAL	SAMARITAN HEALTHCARE	9/15/2023 1:49 PM
Addresses	Main Address	Update	Recertification	1550 S Pioneer Way Moses Lake, WA 98837	1550 S Pioneer Way STE 150/165 Moses Lake, WA 98837	8/17/2023 4:53 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 7:39:36 AM	8/17/2023 4:53:06 PM	8/17/2023 4:53 PM
Details	Entity Subname	Update	Change Request	Samaritan Hospital - Family Medicine - Family Medicine	Samaritan Healthcare - Family Medicine	5/25/2023 10:18 AM
Contacts	Primary Contact	Update	Recertification	O'Brien, Laura Lea 340B Pharmacist Samaritan Healthcare 5097939677	Niehenke, Adam J Controller Samaritan Healthcare 5097939716	9/7/2022 7:39 AM
Details	Last Recertification Date	Update	Recertification	8/18/2021 12:39:06 PM	9/7/2022 7:39:36 AM	9/7/2022 7:39 AM
Details	Last Recertification Date	Update	Recertification		8/18/2021 12:39:06 PM	8/18/2021 12:39 PM
Contacts	Primary Contact	Update		O'Brien, Laura 340B Pharmacist Samaritan Healthcare 5097939677	O'Brien, Laura Lea 340B Pharmacist Samaritan Healthcare 5097939677	7/13/2021 11:05 AM
Contacts	Primary Contact	Update	Change Request	Stever, Lloyd Director of Pharmacy Samaritan Healthcare 5097939677	O'Brien, Laura 340B Pharmacist Samaritan Healthcare 5097939677	7/13/2021 8:03 AM
Details	State	Update		Approved	Active	7/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		Town, Alexander Chief Financial Officer Samaritan Healthcare 5097939710	4/29/2021 9:07 AM
Details	340B ID	Update	New Registration		SCH500033-03	4/29/2021 9:07 AM
Details	Entity Subname	Update	New Registration	Samaritan Hospital - Family Medicine	Samaritan Hospital - Family Medicine - Family Medicine	4/29/2021 9:07 AM
Dates	Participating Approval Date	Update	New Registration		4/29/2021 9:07:07 AM	4/29/2021 9:07 AM
Details	State	Update	New Registration	Pending	Approved	4/29/2021 9:07 AM
Dates	Signed By Date	Update	New Registration		4/23/2021 12:33:55 PM	4/29/2021 9:07 AM
Dates	Start Date	Update	New Registration		7/1/2021 12:00:00 AM	4/29/2021 9:07 AM
Addresses	Main Address	Insert	New Registration		1550 S Pioneer Way Moses Lake, WA 98837	4/13/2021 12:56 PM
Addresses	Shipping Address	Insert	New Registration		Samaritan Hospital 801 E Wheeler Rd Moses Lake, WA 98837	4/13/2021 12:56 PM
Contacts	Primary Contact	Insert	New Registration		Stever, Lloyd Director of Pharmacy Samaritan Healthcare 5097939677	4/13/2021 12:56 PM
Contacts	Authorizing Official	Insert	New Registration		Town, Alexander Chief Financial Officer Samaritan Healthcare 5097939710	4/13/2021 12:56 PM
Details	Assistance Received From Date	Insert	New Registration			4/13/2021 12:56 PM
Details	Assistance Received To Date	Insert	New Registration			4/13/2021 12:56 PM
Details	Last Recertification Date	Insert	New Registration			4/13/2021 12:56 PM
Details	Grant Number	Insert	New Registration			4/13/2021 12:56 PM
Details	340B ID	Insert	New Registration			4/13/2021 12:56 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2021 12:56 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2021 12:56 PM
Details	Medicare Provider Number	Insert	New Registration		500033	4/13/2021 12:56 PM
Details	Entity Name	Insert	New Registration		SAMARITAN HOSPITAL	4/13/2021 12:56 PM
Details	NOFO Number	Insert	New Registration			4/13/2021 12:56 PM
Details	Program Code	Insert	New Registration		SCH	4/13/2021 12:56 PM
Details	Entity Subname	Insert	New Registration		Samaritan Hospital - Family Medicine	4/13/2021 12:56 PM
Dates	Participating Approval Date	Insert	New Registration			4/13/2021 12:56 PM
Details	State	Insert	New Registration		Pending	4/13/2021 12:56 PM
Dates	Registration Date	Insert	New Registration		4/13/2021 12:56:48 PM	4/13/2021 12:56 PM
Dates	Signed By Date	Insert	New Registration			4/13/2021 12:56 PM
Dates	Start Date	Insert	New Registration			4/13/2021 12:56 PM
Terminations	Termination Comments	Insert	New Registration			4/13/2021 12:56 PM
Terminations	Termination Date	Insert	New Registration			4/13/2021 12:56 PM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2021 12:56 PM
Terminations	Termination Reason	Insert	New Registration			4/13/2021 12:56 PM