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SCH500033-17 SAMARITAN HOSPITAL (Terminated)
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Main Details
Name
SAMARITAN HOSPITAL
Subdivision Name
Samaritan Hospital - Occupational Medicine - Occupational Medicine
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH500033-17
Medicare Provider Number
500033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2022
Participating Start Date
1/1/2023
Participating Approval Date
12/13/2022
Last Recertification Date
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Samaritan Healthcare
Alexander Town, Chief Financial Officer
(509) 793-9710
Primary Contact
Samaritan Healthcare
Adam J Niehenke, Controller
(509) 793-9716
Addresses
Street Address
8420 Aspi Blvd.
North Moses Lake, WA 98837
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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