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DSH500079D GOOD SAMARITAN HOSPITAL (Terminated)
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Main Details
Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
GSH WOUND HEALING & HYPERBARIC SVCS - GSH WOUND HEALING & HYPERBARIC SVCS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500079D
Medicare Provider Number
500079
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/21/2017
Last Recertification Date
8/25/2018
Termination Date
Termination Reason
7/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
MULTICARE HEALTH SYSTEM
Florence Chang, President
(253) 403-7355
Primary Contact
MultiCare Health System
Vafa Aflatooni, Director Pharmacy Supply Chain and 340B
(253) 403-2082
Addresses
Street Address
400 15th Avenue SE
Puyallup, WA 98372
Billing Address
MULTICARE HEALTH SYSTEM
PO BOX 5299 MS:737-4-AP
TACOMA, WA 98415
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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