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SCH500030-00 PEACEHEALTH D/B/A ST. JOSEPH MEDICAL CENTER (Terminated)
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Main Details
Name
PEACEHEALTH D/B/A ST. JOSEPH MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH500030-00
Medicare Provider Number
500030
Additional Details
Current Program Status
Terminated
Registration Date
4/30/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/17/2013
Last Recertification Date
8/20/2018
Termination Date
Termination Reason
10/1/2018
Other
Contacts
Authorizing Official
PeaceHealth
DALE ZENDER, CEO
(360) 788-6313
Primary Contact
Peacehealth St Joseph Medical Center
Jeffrey Nicholas Corsentino, Pharmacy Director
(360) 788-6022 Ext: 6022
Addresses
Street Address
2901 SQUALICUM PKWY
BELLINGHAM, WA 98225
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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