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DSH500019 PROVIDENCE HEALTH AND SERVICES - WASHINGTON PROVIDENCE CENTRALIA (Active)
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Main Details
Name
PROVIDENCE HEALTH AND SERVICES - WASHINGTON PROVIDENCE CENTRALIA
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH500019
Medicare Provider Number
500019
Additional Details
Current Program Status
Active
Registration Date
11/30/2006
Participating Start Date
1/1/2007
Participating Approval Date
12/1/2006
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Providence Health & Services
Marna Leonard, Chief Financial Officer
(206) 992-8229
Primary Contact
Providence St. Peter Hospital
Andrea Christan Hall, Senior Manager Pharmacy Ambulatory
(360) 523-2953
Addresses
Street Address
914 SOUTH SCHEUBER ROAD
CENTRALIA, WA 98531
Billing Address
Providence St Joseph Health
PO BOX 31263
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/7/08 UPDATED ENTITY NAME (WAS SOUTHWEST SERVICE AREA PROVIDENCE CENTRALIA HOSPITAL); 1/1/08 UPDATED ENTITY NAME(WAS PROVIDENCE CENTRALIA HOSPITAL)
11/30/2006
May 2025
May 2025
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