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DSH500014S PROVIDENCE HEALTH & SERVICES - WASHINGTON (Active)
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Main Details
Name
PROVIDENCE HEALTH & SERVICES - WASHINGTON
Subdivision Name
Providence Regional Medical Center Everett Colby Campus - Anticoagulation Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500014S
Medicare Provider Number
500014
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/6/2019
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Providence Health & Services Washington
Scott Combs, CFO
(425) 261-4044
Primary Contact
Providence Health & Services Washington
Eric Werttemberger, Director of Pharmacy
(425) 261-3530
Addresses
Street Address
1330 Rockefeller Ave
Suite 150
Everett, WA 98201
Billing Address
Providence Saint Joseph Health
PO Box 31263
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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