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DSH500108E ST. JOSEPH MEDICAL CENTER (Terminated)
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Main Details
Name
ST. JOSEPH MEDICAL CENTER
Subdivision Name
Franciscan Dialysis Eastside
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500108E
Medicare Provider Number
500108
Outpatient Facility Provider Number
502307
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
1415 E 72nd Street
Tacoma, WA 98404
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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