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DSH500084 EVERGREEN HEALTH MONROE (Terminated)
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Main Details
Name
EVERGREEN HEALTH MONROE
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500084
Medicare Provider Number
500084
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/31/2016
Last Recertification Date
8/24/2018
Termination Date
Termination Reason
10/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Evergreenhealth Monroe
John Green
(360) 794-7497 Ext: 1246
Primary Contact
EvergreenHealth Monroe
Daniel Decker, Director of Pharmacy
(360) 794-7497 Ext: 3638
Addresses
Street Address
14701 179TH SE
MONROE, WA 98272-0646
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/31/16 Participated starting 10/1/2011, terminated 1/1/2013. Reinstated 1/1/2017.
10/31/2016
DSH adjustment % fell below 11.75%, for the CR filed on 5/29/12 for CR Period of 1/1/11 to 12/31/11. Entity stopped using 340B on 9/27/12.
12/06/2012
April 2025
April 2025
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