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DSH500049 WALLA WALLA GENERAL HOSPITAL (Terminated)
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Main Details
Name
WALLA WALLA GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH500049
Medicare Provider Number
500049
Additional Details
Current Program Status
Terminated
Registration Date
6/1/2006
Participating Start Date
7/1/2006
Participating Approval Date
6/5/2006
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Thomas Jacobsen, Corporate Director of Pharmacy
(916) 781-4648
Primary Contact
Adventist Health Pharmacy
Geoff Jones, Director of Pharmacy
(509) 527-8268
Addresses
Street Address
1025 SOUTH SECOND AVE.
WALLA WALLA, WA 99362
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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01/21/11 REMOVED MEDICAID#(WAS 3303203)
01/21/2011
May 2025
May 2025
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