340B Drug Pricing Program Database
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DSH500050L PeaceHealth Southwest Medical Center (Active)
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Main Details
Name
PeaceHealth Southwest Medical Center
Subdivision Name
PEACEHEALTH SOUTHWEST MEDICAL CENTER / Wound Healing Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500050L
Medicare Provider Number
500050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/25/2016
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
PeaceHealth, Columbia Network
Tracey Fernandez, CFO
(360) 514-3548
Primary Contact
PeaceHealth
Adriane Kindell, 340B Program Supervisor
(360) 414-2137
Addresses
Street Address
8716 E MILL PLAIN BLVD
SW SPECIALTY SERVICES
VANCOUVER, WA 98664-2531
Billing Address
PeaceHealth
1115 SE 164th Ave
Ste. 332
Vancouver, WA 98683
Comments
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