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DSH500041 PEACEHEALTH ST. JOHN MEDICAL CENTER (Active)
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Main Details
Name
PEACEHEALTH ST. JOHN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500041
Medicare Provider Number
500041
Additional Details
Current Program Status
Active
Registration Date
4/28/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/28/2008
Last Recertification Date
8/19/2024
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
1615 DELAWARE ST
LONGVIEW, WA 98632
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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8/17/11 UPDATE ENTITY NAME (WAS ST. JOHN MEDICAL CENTER)
08/17/2011
April 2025
April 2025
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