Covered Entity Details

DSH500030N ST. JOSEPH MEDICAL CENTER (Active) - information as of 6/16/2025 2:15:20 AM

Main Details

Name

ST. JOSEPH MEDICAL CENTER

Subdivision Name

PeaceHealth Cardiovascular Imaging Center - Vascular Lab

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH500030N

Medicare Provider Number

500030

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/5/2022

Participating Start Date

1/1/2023

Participating Approval Date

11/16/2022

Last Recertification Date

8/16/2024

Contacts

Authorizing Official

Peacehealth.org
Krista N Touros, CFO
(360) 788-6754 Ext: 6754

Primary Contact

Peacehealth St Joseph Medical Center
Jeffrey Nicholas Corsentino, Pharmacy Director
(360) 788-6022 Ext: 6022

Addresses

Street Address

2980 Squalicum Parkway, Suite #219
Bellingham, WA 98225

Billing Address

PeaceHealth
1115 SE 164th Ave, Ste. 332
Vancouver, WA 98683

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	2023356	1487904546

Shipping Addresses

Shipping Address 1

PeaceHealth St Joseph Medical Center
2901 Squalicum Parkway
Bellingham, WA 98225

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
DSH500030A	Child	DSH	ST. JOSEPH MEDICAL CENTER	SJMC Radiation Therapy	3301 Squalicum Pkwy	Bellingham	WA	Active
DSH500030C	Child	DSH	ST. JOSEPH MEDICAL CENTER	SJMC Wound Healing Center	4280 Meridian St. Ste. 101	Bellingham	WA	Active
DSH500030D	Child	DSH	ST. JOSEPH MEDICAL CENTER	SJMC Center for Senior Health	3015 Squalicum Pkwy, Ste. 100	Bellingham	WA	Active
DSH500030E	Child	DSH	ST. JOSEPH MEDICAL CENTER	SJMC Neurology	710 Birchwood Ave. Ste. 201	Bellingham	WA	Active
DSH500030F	Child	DSH	ST. JOSEPH MEDICAL CENTER	SJMC Orthopedics Main	3015 Squalicum Pkwy. Ste. 200	Bellingham	WA	Active
DSH500030G	Child	DSH	ST. JOSEPH MEDICAL CENTER	SJMC Orthopedics Lynden	1610 Grover St. Ste. C6	Lynden	WA	Terminated
DSH500030H	Child	DSH	ST. JOSEPH MEDICAL CENTER	SJMC Regional Infusion Center	3301 Squalicum Pkwy	Bellingham	WA	Active
DSH500030J	Child	DSH	ST. JOSEPH MEDICAL CENTER	PEACEHEALTH - SJMC NUCLEAR MEDICINE-CARDIOLOGY	2979 SQUALICUM PKWY 101	BELLINGHAM	WA	Terminated
DSH500030K	Child	DSH	ST. JOSEPH MEDICAL CENTER	PEACEHEALTH - PEACEHEALTH ST JOSEPH MEDICAL CANCER CENTER	3301 SQUALICUM PKWY	BELLINGHAM	WA	Active
DSH500030L	Child	DSH	ST. JOSEPH MEDICAL CENTER	PeaceHealth Cardiovascular Imaging Center - Nuclear Medicine	2980 Squalicum Parkway	Bellingham	WA	Active
DSH500030M	Child	DSH	ST. JOSEPH MEDICAL CENTER	PeaceHealth Cardiovascular Imaging Center - Cardiac Recovery	2980 Squalicum Parkway, Suite 219	Bellingham	WA	Active
DSH500030N	Child	DSH	ST. JOSEPH MEDICAL CENTER	PeaceHealth Cardiovascular Imaging Center - Vascular Lab	2980 Squalicum Parkway, Suite #219	Bellingham	WA	Active
DSH500030P	Child	DSH	ST. JOSEPH MEDICAL CENTER	PeaceHealth Cardiovascular Imaging Center - Echo	2980 Squalicum Parkway, Suite #219	Bellingham	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/17/2023 2:16:11 PM	8/16/2024 6:22:58 PM	8/16/2024 6:22 PM
Details	Last Recertification Date	Update	Recertification		8/17/2023 2:16:11 PM	8/17/2023 2:16 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Touros, Krista N CFO Peacehealth.org 3607886754-6754	11/16/2022 7:14 AM
Details	340B ID	Update	New Registration		DSH500030N	11/16/2022 7:14 AM
Details	Entity Subname	Update	New Registration	PeaceHealth Cardiovascular Imaging Center	PeaceHealth Cardiovascular Imaging Center - Vascular Lab	11/16/2022 7:14 AM
Dates	Participating Approval Date	Update	New Registration		11/16/2022 7:14:53 AM	11/16/2022 7:14 AM
Details	State	Update	New Registration	Pending	Approved	11/16/2022 7:14 AM
Dates	Signed By Date	Update	New Registration		10/6/2022 11:01:51 AM	11/16/2022 7:14 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	11/16/2022 7:14 AM
Addresses	Main Address	Insert	New Registration		2980 Squalicum Parkway, Suite #219 Bellingham, WA 98225	10/5/2022 8:11 PM
Addresses	Billing Address	Insert	New Registration		PeaceHealth 1115 SE 164th Ave, Ste. 332 Vancouver, WA 98683	10/5/2022 8:11 PM
Addresses	Shipping Address	Insert	New Registration		PeaceHealth St Joseph Medical Center 2901 Squalicum Parkway Bellingham, WA 98225	10/5/2022 8:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/5/2022 8:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		2023356	10/5/2022 8:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		WA	10/5/2022 8:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1487904546	10/5/2022 8:11 PM
Medicaid Billing	NPI: State	Insert	New Registration		WA	10/5/2022 8:11 PM
Contacts	Primary Contact	Insert	New Registration		Corsentino, Jeffrey Nicholas Pharmacy Director Peacehealth St Joseph Medical Center 3607886022-6022	10/5/2022 8:11 PM
Contacts	Authorizing Official	Insert	New Registration		Touros, Krista N CFO Peacehealth.org 3607886754-6754	10/5/2022 8:11 PM
Details	Assistance Received From Date	Insert	New Registration			10/5/2022 8:11 PM
Details	Assistance Received To Date	Insert	New Registration			10/5/2022 8:11 PM
Details	Last Recertification Date	Insert	New Registration			10/5/2022 8:11 PM
Details	Grant Number	Insert	New Registration			10/5/2022 8:11 PM
Details	340B ID	Insert	New Registration			10/5/2022 8:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/5/2022 8:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/5/2022 8:11 PM
Details	Medicare Provider Number	Insert	New Registration		500030	10/5/2022 8:11 PM
Details	Entity Name	Insert	New Registration		ST. JOSEPH MEDICAL CENTER	10/5/2022 8:11 PM
Details	NOFO Number	Insert	New Registration			10/5/2022 8:11 PM
Details	Program Code	Insert	New Registration		DSH	10/5/2022 8:11 PM
Details	Entity Subname	Insert	New Registration		PeaceHealth Cardiovascular Imaging Center	10/5/2022 8:11 PM
Dates	Participating Approval Date	Insert	New Registration			10/5/2022 8:11 PM
Details	State	Insert	New Registration		Pending	10/5/2022 8:11 PM
Dates	Registration Date	Insert	New Registration		10/5/2022 8:11:17 PM	10/5/2022 8:11 PM
Dates	Signed By Date	Insert	New Registration			10/5/2022 8:11 PM
Dates	Start Date	Insert	New Registration			10/5/2022 8:11 PM
Terminations	Termination Comments	Insert	New Registration			10/5/2022 8:11 PM
Terminations	Termination Date	Insert	New Registration			10/5/2022 8:11 PM
Terminations	Termination Effective Date	Insert	New Registration			10/5/2022 8:11 PM
Terminations	Termination Reason	Insert	New Registration			10/5/2022 8:11 PM