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DSH500050F PeaceHealth Southwest Medical Center (Terminated)
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Main Details
Name
PeaceHealth Southwest Medical Center
Subdivision Name
Memorial Health Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500050F
Medicare Provider Number
500050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/17/2013
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
7/1/2019
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
PeaceHealth Columbia Network
Sean Gregory, Chief Executive
(360) 514-2082
Primary Contact
PeaceHealth
Adriane Kindell, 340B Program Supervisor
(360) 414-2137
Addresses
Street Address
3400 Main Street
Vancouver, WA 98663
Billing Address
PeaceHealth
1115 SE 164th Ave
Vancouver, WA 98683
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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