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PROVIDENCE HEALTH & SERVICES-WASHINGTON
DSH500077 PROVIDENCE HEALTH & SERVICES-WASHINGTON
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH & SERVICES-WASHINGTON
Subdivision Name
PROVIDENCE HOLY FAMILY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH500077
Entity Address
5633 NORTH LIDGERWOOD STREET
SPOKANE, WA 99208
Medicare Provider Number
500077
Participating Start Date
7/1/2010
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
PROVIDENCE HEALTH & SERVICES-WASHINGTON
Pharmacy Address
PROVIDENCE SACRED HEART OUTPATIENT PHARM
101 W 8TH AVE
STE 207653
SPOKANE, WA 99204-2307
Pharmacy Comments
Contract Details
Approval Date
12/8/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Helen Andrus, CFO
(509) 474-3307
Contract Pharmacy Representative
Providence Heath & Services
Eric H Reimer, Pharmacist in Charge
(509) 474-4569
Signed By Date
12/8/2017
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