340B Drug Pricing Program Database
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DSH500003B SKAGIT VALLEY HOSPITAL (Terminated)
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Main Details
Name
SKAGIT VALLEY HOSPITAL
Subdivision Name
SKAGIT VALLEY KIDNEY CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500003B
Medicare Provider Number
500003
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/2/2006
Participating Start Date
7/1/2006
Participating Approval Date
5/3/2006
Last Recertification Date
8/27/2018
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Skagit Valley Hospital
Paul Ishizuka, CFO
(360) 814-5838
Primary Contact
Skagit Valley Hospital.
Alma Martinez, 340B Program Manager
(360) 814-5001
Addresses
Street Address
208 HOSPITAL PARKWAY
MOUNT VERNON, WA 98274-4126
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/7/08 UPDATED ADDR (WAS 1415 EAST KINCAID); 9/4/2007 DOC RECD TO CONFIRM ELIG DSH ADJ %
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