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DSH500079A GOOD SAMARITAN HOSPITAL (Active)
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Main Details
Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
MULTICARE GOOD SAMARITAN HOSPICE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500079A
Medicare Provider Number
500079
Outpatient Facility Provider Number
501508
Additional Details
Current Program Status
Active
Registration Date
7/17/2023
Participating Start Date
10/1/2023
Participating Approval Date
9/5/2023
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
3901 SOUTH FIFE STREET
TACOMA, WA 98409-7309
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 from effective date: (10/1/2016) until terminated effective date: (07/1/2019), reinstatement effective date: (10/1/2023)
09/05/2023
April 2025
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