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DSH500044 DEACONESS MEDICAL CENTER (Active)
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Main Details
Name
DEACONESS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500044
Medicare Provider Number
500044
Additional Details
Current Program Status
Active
Registration Date
10/10/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/19/2018
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
MultiCare Health System
Timothy Wayne Lynch, Sr. VP, Chief Administrative Officer
(253) 403-2824
Primary Contact
MultiCare Health System
Cindy Wilson, Assistant Vice President - Pharmacy Compliance
(253) 403-2822
Addresses
Street Address
800 W 5TH AVENUE
SPOKANE, WA 99204
Billing Address
MULTICARE HEALTH SYSTEM
PO Box 5299
MS 1313-5-AP
Tacoma, WA 98415-0299
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Initial start 1/1/2005, Termination 10/1/2008, Reinstate 1/1/2019
10/12/2018
5/25/05 - ADD MED#; 7/12/06 - ADD IDAHO MED#; 10/1/2008 - OPA NOTIFIED ON 10/1/08 THAT HOSPITAL CHANGED OWNERSHIP TO FOR-PROFIT STATUS AND TERMINATED
10/01/2008
June 2025
June 2025
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