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DSH500036B YAKIMA VALLEY MEMORIAL HOSPITAL (Active)
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Main Details
Name
YAKIMA VALLEY MEMORIAL HOSPITAL
Subdivision Name
INFUSION CARE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500036B
Medicare Provider Number
500036
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/4/2007
Participating Start Date
7/1/2004
Participating Approval Date
9/4/2007
Last Recertification Date
8/17/2024
Contacts
Authorizing Official
Yakima Valley Memorial Hospital
Tammy K. Buyok, President and Market Leader
(509) 575-8001
Primary Contact
Yakima Valley Memorial Hospital
Jake Aaron Bradshaw, Director of Pharmacy
(509) 746-2002
Addresses
Street Address
808 N. 39th Ave
YAKIMA, WA 98902
Billing Address
Yakima Valley Memorial Hospital
PO Box: 5299
MS 1313-5-AP
Tacoma, WA 98415-0299
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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MEDICAID CARVEOUT EFFECTIVE 10/1/2006 (MEDICAID # WAS 6001309)
09/04/2007
May 2025
May 2025
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