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DSH500053N KENNEWICK GENERAL HOSPITAL (Terminated)
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Main Details
Name
KENNEWICK GENERAL HOSPITAL
Subdivision Name
KGH - Cardiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500053N
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
8/11/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
RCCH Trios Health, LLC
Jason Hotchkiss, CFO
(509) 221-5735
Primary Contact
Kennewick Public Hospital District
Tony Sudduth, CFO
(509) 221-5349
Addresses
Street Address
4309 W 27th Place, Suite 301
Kennewick, WA 99336
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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