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DSH500014V PROVIDENCE HEALTH & SERVICES - WASHINGTON (Active)
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Main Details
Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
PROV REGIONAL MED CTR EVERETT - Anticoagulation 1401.500040.12349
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500014V
Medicare Provider Number
500014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/2/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/8/2024
Last Recertification Date
Contacts
Authorizing Official
Providence Health & Services Washington
Scott Combs, CFO
(425) 261-4044
Primary Contact
Providence Health & Services Washington
Eric Werttemberger, Director of Pharmacy
(425) 261-3530
Addresses
Street Address
19200 N KELSEY ST
MONROE, WA 98272-1431
Billing Address
Providence Saint Joseph Health
PO Box 31263
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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