340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH500002 PROV ST MARY MEDICAL CENTER (Terminated)
Print
Main Details
Name
PROV ST MARY MEDICAL CENTER
Subdivision Name
Providence St. Mary Medical Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500002
Medicare Provider Number
500002
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/31/2022
Last Recertification Date
8/30/2023
Termination Date
Termination Reason
7/1/2024
Change of covered entity type
Contacts
Authorizing Official
Kadlec Regional Medical Center
Spencer Dwayne Harris, CFO
(509) 942-2708
Primary Contact
Providence St Mary Medical Center
Belinda Grimm, 340B Coordinator
(509) 897-2087
Addresses
Street Address
401 W POPLAR ST.
WALLA WALLA, WA 99362-2846
Billing Address
PROVIDENCE ACCOUNTS PAYABLE
P.O. BOX 696430
SAN ANTONIO, TX 78269-0000
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
1
to
4
of
4
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
4
of
4
Page:
of 1
Go
Page size:
Change
Participated starting 10/1/2016; Terminated 7/1/2020; Reinstated 10/1/2022.
08/29/2022
“The Office of Pharmacy Affairs recognizes that any Contract Pharmacy for DSH500002 with a termination date of 4/14/2020 is active until 7/1/2020.”
05/04/2020
Participated as DSH starting 4/1/2006, terminated 4/1/2007, then participated as RRC starting 8/11/2010, terminating 10/1/16 when reinstated as a DSH starting 10/1/2016;
09/13/2016
3/31/06 - NEW CONTACT
03/30/2007
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session