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DSH500026 SWEDISH EDMONDS (Active)
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Main Details
Name
SWEDISH EDMONDS
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500026
Medicare Provider Number
500026
Additional Details
Current Program Status
Active
Registration Date
10/8/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
Contacts
Authorizing Official
Providence Health & Services Washington
Scott Combs, CFO
(425) 261-4044
Primary Contact
Providence/Swedish
Melisa G Lea, 340B Program Manager
(206) 756-0546
Addresses
Street Address
21601 76TH AVENUE WEST
EDMONDS, WA 98026-7507
Billing Address
Providence St Joseph Health
PO BOX 31263
Salt Lake City, UT 84131-9673
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date7/1/2010, Termination 10/1/2024, Reinstatement 1/1/2025
10/09/2024
9/16/10 UPDATED ENTITY NAME (WAS STEVENS HOSPITAL); 8/16/10 ADDED SHIP TO; 6/16/10 DOC RECD TO CONFIRM ELIG DSH ADJ %;
06/15/2010
May 2025
May 2025
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