340B Drug Pricing Program Database
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DSH500050G PeaceHealth Southwest Medical Center (Terminated)
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Main Details
Name
PeaceHealth Southwest Medical Center
Subdivision Name
Ray Hickey Hospice House
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500050G
Medicare Provider Number
500050
Outpatient Facility Provider Number
501501
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
1/1/2019
Business decision by the Covered Entity
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
2112 East Mill Plain Boulevard
Vancouver, WA 98661
Billing Address
PeaceHealth
1115 SE 164th Ave
Vancouver, WA 98683
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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