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DSH500079 GOOD SAMARITAN HOSPITAL (Active)
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Main Details
Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500079
Medicare Provider Number
500079
Additional Details
Current Program Status
Active
Registration Date
10/14/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/30/2021
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
MultiCare Health System
Timothy Wayne Lynch, Sr. VP, Chief Administrative Officer
(253) 403-2824
Primary Contact
MultiCare Health System
Cindy Wilson, Assistant Vice President - Pharmacy Compliance
(253) 403-2822
Addresses
Street Address
401 15th Avenue SE
PUYALLUP, WA 98372
Billing Address
Multicare Good Samaritan Hospital
PO Box 5299
MS 1313-5-AP
Tacoma, WA 98415-0299
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating starting 1/1/2015; Terminated 7/1/2019; Reinstated 1/1/2022.
11/30/2021
May 2025
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