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DSH500021 ST. CLARE HOSPITAL (Active)
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Main Details
Name
ST. CLARE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500021
Medicare Provider Number
500021
Additional Details
Current Program Status
Active
Registration Date
9/12/2008
Participating Start Date
10/1/2009
Participating Approval Date
9/23/2009
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Virginia Mason Franciscan Health
David Nosacka, SVP and CFO
(253) 680-4005
Primary Contact
st clare hospital
janet topasna, Director of Pharmacy
(253) 985-2780
Addresses
Street Address
11315 BRIDGEPORT WAY SW
LAKEWOOD, WA 98499
Billing Address
CHI Accounts Payable Center
PO Box 636000
Littleton, CO 80163-6000
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/1/09 REINSTATED ORIG PART FROM 9/19/08 TO 6/30/2009, NOT ELIG FROM 7/1/200 TO 9/30/2009; 8/4/2009 DOC RECD TO CONFIRM ELIG DSH ADJ%; ORIG PART AS DSH98499 FROM 4/1/05 THROUGH 9/30/2006, INELIG 10/1/06 THROUGH 9/18/08
09/23/2009
April 2025
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