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DSH500050 PeaceHealth Southwest Medical Center (Active)
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Main Details
Name
PeaceHealth Southwest Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500050
Medicare Provider Number
500050
Additional Details
Current Program Status
Active
Registration Date
8/29/2007
Participating Start Date
4/1/2005
Participating Approval Date
8/29/2007
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
PeaceHealth, Columbia Network
Tracey Fernandez, CFO
(360) 514-3548
Primary Contact
PeaceHealth
Adriane Kindell, 340B Program Supervisor
(360) 414-2137
Addresses
Street Address
400 NE Mother Joseph Place
VANCOUVER, WA 98664
Billing Address
PeaceHealth
1115 SE 164th Ave
Ste. 332
Vancouver, WA 98683
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/5/11 NEW ENTITY NAME (WAS SOUTHWEST WASHINGTON MEDICAL CENTER); 12/28/2010- DOC. SUBMITTED TO CONFIRM ELIG. DSH %; 6/30/2010 SHIP TO ADDED - 8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
08/05/2011
12/28/2010- DOC. SUBMITTED TO CONFIRM ELIG. DSH %; 6/30/2010 SHIP TO ADDED - 8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
06/30/2010
12/28/2010- DOC. SUBMITTED TO CONFIRM ELIG. DSH %; 6/30/2010 SHIP TO ADDED - 8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %
06/30/2010
June 2025
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