340B Drug Pricing Program Database
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DSH500088X PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER (Terminated)
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Main Details
Name
PUBLIC HOSPITAL DISTRICT NO 1 OF KING COUNTY DBA VALLEY MEDICAL CENTER
Subdivision Name
Maple Valley Primary Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500088X
Medicare Provider Number
500088
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/17/2016
Last Recertification Date
8/25/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Public Hospital District No 1 of King County
Jeannine Grinnell, Chief Executive and Financial Officer
(425) 690-3310
Primary Contact
Public Hospital District No. 1 of King County
Kenneth Kenyon, VP Pharmacy Services
(425) 690-3155
Addresses
Street Address
26458 Maple Valley Black Diamond Rd SE
Maple Valley, WA 98038
Billing Address
Public Hospital District No. 1 of King County DBA Valley Medical Center
PO Box 50010
400 South 43rd Street
Renton, WA 98058
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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