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DSH500129CC TACOMA GENERAL/ALLENMORE HOSPITAL (Terminated)
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Main Details
Name
TACOMA GENERAL/ALLENMORE HOSPITAL
Subdivision Name
MULTICARE HEALTH SYSTEM - AH DIABETES SERVICES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500129CC
Medicare Provider Number
500129
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/13/2017
Last Recertification Date
9/9/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
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
3124 South 19th, Suite 140
TACOMA, WA 98405
Billing Address
MULTICARE HEALTH SYSTEM
PO Box 5299
MS 1313-5-AP
TACOMA, WA 98415-0299
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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