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DSH500053D KENNEWICK GENERAL HOSPITAL (Terminated)
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Main Details
Name
KENNEWICK GENERAL HOSPITAL
Subdivision Name
KGh Medical Group
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500053D
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
KGH Medical Group at Evergreen
721 S. Auburn St
Kennewick, WA 99336
Billing Address
KGH Medical Group
900 S Auburn St
Kennewick, WA 99336
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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