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DSH500053Q KENNEWICK GENERAL HOSPITAL (Terminated)
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Main Details
Name
KENNEWICK GENERAL HOSPITAL
Subdivision Name
KGH Surgical
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500053Q
Medicare Provider Number
500053
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
12/6/2017
Termination Date
Termination Reason
10/1/2018
For-Profit conversion
Contacts
Authorizing Official
RCCH Trios Health, LLC
Jason Hotchkiss, CFO
(509) 221-5735
Primary Contact
Kennewick Public Hospital District
MICHAEL Robert-Reece PORTER, DIRECTOR OF PHARMACY
(509) 221-5788
Addresses
Street Address
216 W 10TH AVE STE 204
KGH DR E DIZON
KENNEWICK, WA 99336-6304
Billing Address
KGH Medical Group
900 S Auburn Street
Kennewick, WA 99336
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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