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DSH500014 PROVIDENCE HEALTH & SERVICES - WASHINGTON (Active)
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Main Details
Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
PROVIDENCE REGIONAL MEDICAL CENTER EVERETT COLBY CAMPUS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500014
Medicare Provider Number
500014
Additional Details
Current Program Status
Active
Registration Date
1/7/2008
Participating Start Date
4/1/2005
Participating Approval Date
1/7/2008
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Providence Health & Services Washington
Scott Combs, CFO
(425) 261-4044
Primary Contact
Providence Health & Services Washington
Eric Werttemberger, Director of Pharmacy
(425) 261-3530
Addresses
Street Address
1321 COLBY AVENUE
EVERETT, WA 98201
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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5/27/09 DOC RECD TO CONFIRM ELIG DSH ADJ%; 1/2/09 NAME CHANGE (WAS PROVIDENCE EVERETT MEDICAL CENTER); 11/10/08 ADDED SUBDIV NAME; 7/1/08-ADDED MEDICAID #; 9/26/05 - DELETE MEDICAID #
12/10/2010
5/27/09 DOC RECD TO CONFIRM ELIG DSH ADJ%; 1/2/09 NAME CHANGE (WAS PROVIDENCE EVERETT MEDICAL CENTER); 11/10/08 ADDED SUBDIV NAME; 7/1/08-ADDED MEDICAID #; 9/26/05 - DELETE MEDICAID #
01/07/2008
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