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DSH500054 PROVIDENCE HEALTH & SERVICES - WASHINGTON (Active)
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Main Details
Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
PROVIDENCE SACRED HEART MEDICAL CENTER AND CHILDREN'S HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500054
Medicare Provider Number
500054
Additional Details
Current Program Status
Active
Registration Date
10/16/2007
Participating Start Date
1/1/2005
Participating Approval Date
10/16/2007
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Providence Health & Services - WA
Justin Boyd Voelker, Chief Financial Officer
(509) 474-3040
Primary Contact
Providence Health & Services - WA
Michelle Sodorff, Director, Pharmacy
(509) 474-3232
Addresses
Street Address
101 WEST 8TH AVENUE
SPOKANE, WA 99204
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/23/12 Added NPI#; 12/2/08 UPDATED ENTITY NAME (WAS SACRED HEART MEDICAL CENTER); 8/25/08 ADDED MEDICAID #; 6/1/07 UPDATED ADDR (WAS ZIP: 99220); 7/10/06 REMOVED MEDICAID #(WAS 6606605);
03/23/2012
12/2/08 UPDATED ENTITY NAME (WAS SACRED HEART MEDICAL CENTER); 8/25/08 ADDED MEDICAID #; 6/1/07 UPDATED ADDR (WAS ZIP: 99220); 7/10/06 REMOVED MEDICAID #(WAS 6606605);
01/22/2010
April 2025
April 2025
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