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DSH500077 PROVIDENCE HEALTH & SERVICES-WASHINGTON (Active)
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Main Details
Name
PROVIDENCE HEALTH & SERVICES-WASHINGTON
Subdivision Name
PROVIDENCE HOLY FAMILY HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500077
Medicare Provider Number
500077
Additional Details
Current Program Status
Active
Registration Date
6/15/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/16/2010
Last Recertification Date
9/11/2024
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) 474-3242
Addresses
Street Address
5633 NORTH LIDGERWOOD STREET
SPOKANE, WA 99208
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/23/12 Added NPI#; 6/16/10 - DOC RECD TO CONFIRM ELIG DSH ADJ %
03/23/2012
6/16/10 - DOC RECD TO CONFIRM ELIG DSH ADJ %
06/16/2010
May 2025
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