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DSH500108D ST. JOSEPH MEDICAL CENTER (Terminated)
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Main Details
Name
ST. JOSEPH MEDICAL CENTER
Subdivision Name
St. Joseph Dialysis Center-Gig Harbor
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500108D
Medicare Provider Number
500108
Outpatient Facility Provider Number
503510
Additional Details
Current Program Status
Terminated
Registration Date
2/14/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/30/2012
Last Recertification Date
8/16/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
CHI Franciscan Health
Mike Fitzgerald, CFO
(253) 680-4005
Primary Contact
CHI Franciscan Health
Cindy Wilson, 340B Program Manager
(253) 426-6692
Addresses
Street Address
4700 Point Fosdick Drive NW
Suite 101
Gig Harbor, WA 98335
Billing Address
St Joseph Medical Center
PO Box 63600
Littleton, CO 80163-6000
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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