340B Drug Pricing Program Database
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DSH500030G ST. JOSEPH MEDICAL CENTER (Terminated)
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Main Details
Name
ST. JOSEPH MEDICAL CENTER
Subdivision Name
SJMC Orthopedics Lynden
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH500030G
Medicare Provider Number
500030
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/30/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/31/2018
Last Recertification Date
8/30/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Peacehealth.org
Krista N Touros, CFO
(360) 788-6754 Ext: 6754
Primary Contact
Peacehealth St Joseph Medical Center
Jeffrey Nicholas Corsentino, Pharmacy Director
(360) 788-6022 Ext: 6022
Addresses
Street Address
1610 Grover St. Ste. C6
Lynden, WA 98264
Billing Address
PeaceHealth
1115 SE 164th Ave, Ste 332
Vancouver, WA 98683
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2013, terminated 7/1/2013. Reinstated 10/1/2018.
08/31/2018
June 2025
June 2025
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