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DSH500079B GOOD SAMARITAN HOSPITAL (Active)
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Main Details
Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
GSH PET/CT SCAN - GSH PET/CT SCAN
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500079B
Medicare Provider Number
500079
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/25/2023
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
400 15th Avenue South East
Puyallup, WA 98372
Billing Address
MULTICARE HEALTH SYSTEM
PO BOX 5299 MS:1313-5-AP
TACOMA, WA 98415
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2018; Terminated 7/1/2019; Reinstated 1/1/2024.
10/25/2023
April 2025
April 2025
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