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DSH500058AF Kadlec Regional Medical Center (Terminated)
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Main Details
Name
Kadlec Regional Medical Center
Subdivision Name
South Richland Primary Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH500058AF
Medicare Provider Number
500058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/24/2017
Last Recertification Date
9/8/2021
Termination Date
Termination Reason
4/1/2022
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Kadlec Regional Medical Center
Spencer Dwayne Harris, CFO
(509) 942-2708
Primary Contact
Kadlec Regional Medical Center
C.J. Cahoon, Director of Pharmacy
(509) 946-4611 Ext: 4263
Addresses
Street Address
560 Gage Blvd
Suite 206
Richland, WA 99352
Billing Address
Kadlec Regional Medical Center
PO Box 389673
Seattle, WA 98138
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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