340B Drug Pricing Program Database
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DSH500050E PeaceHealth Southwest Medical Center (Active)
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Main Details
Name
PeaceHealth Southwest Medical Center
Subdivision Name
PHSW Regional Cancer Center Infusion Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500050E
Medicare Provider Number
500050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/17/2013
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
PeaceHealth, Columbia Network
Tracey Fernandez, CFO
(360) 514-3548
Primary Contact
PeaceHealth
Adriane Kindell, 340B Program Supervisor
(360) 414-2137
Addresses
Street Address
505 NE 87th Avenue
Suite 350
Vancouver, WA 98684
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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