Covered Entity Details

CAH501319-02 LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH (Active) - information as of 6/17/2025 11:45:20 PM

Main Details

Name

LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH

Subdivision Name

MOSSYROCK CLINIC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH501319-02

Medicare Provider Number

501319

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/14/2016

Participating Start Date

1/1/2017

Participating Approval Date

12/8/2016

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

A
Clint Scogin, Controller
(360) 496-3713

Primary Contact

Morton General Hospital
Shana Garcia, Executive Assistant
(360) 496-3537

Addresses

Street Address

745 WILLIAMS ST
MOSSYROCK, WA 98564-9004

Billing Address

LEWIS COUNTY HOSPITAL DISTRICT #1 DBA MORTON GENERAL HOSPITAL
PO Box 1138
Morton, WA 98356

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH501319-01	Child	CAH	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH	RANDLE CLINIC	108 KINDLE RD	RANDLE	WA	Active
CAH501319-02	Child	CAH	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH	MOSSYROCK CLINIC	745 WILLIAMS ST	MOSSYROCK	WA	Active
CAH501319-03	Child	CAH	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH	Womens Clinic	521 Adams Avenue	Morton	WA	Active
CAH501319-04	Child	CAH	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH	SPECIALTY CLINIC	521 ADAMS AVE	MORTON	WA	Active
CAH501319-05	Child	CAH	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH	RAPID CARE CLINIC - Walk in clinic	521 Adams Ave	Morton	WA	Active
CAH501319-06	Child	CAH	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH	MORTON CLINIC - Family practice	521 Adams Ave	Morton	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Cornwell, Cheryl J CFO Arbor Health 3604963647	Scogin, Clint Controller A 3604963713	4/21/2025 2:09 PM
Details	Last Recertification Date	Update	Recertification	8/16/2023 1:51:52 PM	8/29/2024 12:40:20 PM	8/29/2024 12:40 PM
Details	Entity Subname	Update	Change Request	RIFFE MEDICAL CENTER	MOSSYROCK CLINIC	10/23/2023 12:11 PM
Details	Last Recertification Date	Update	Recertification	9/16/2022 11:35:40 AM	8/16/2023 1:51:52 PM	8/16/2023 1:51 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 1:11:57 PM	9/16/2022 11:35:40 AM	9/16/2022 11:35 AM
Contacts	Authorizing Official	Update	AO Change Request	Boggess, Richard CHIEF FINANCIAL OFFICER Arbor Health 3604963647	Cornwell, Cheryl J CFO Arbor Health 3604963647	9/16/2022 6:34 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 7:47:36 PM	8/16/2021 1:11:57 PM	8/16/2021 1:11 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	3081601 (WA)		8/18/2020 7:47 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1184908410 ( )		8/18/2020 7:47 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1205882909 ( )		8/18/2020 7:47 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1386679777 ( )		8/18/2020 7:47 PM
Details	Last Recertification Date	Update	Recertification	9/9/2019 11:48:58 AM	8/18/2020 7:47:36 PM	8/18/2020 7:47 PM
Details	Last Recertification Date	Update	Recertification	8/27/2018 12:22:30 PM	9/9/2019 11:48:58 AM	9/9/2019 11:48 AM
Details	Entity Name	Update	Change Request	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA MORTON GENERAL HOSPITAL	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA ARBOR HEALTH	6/10/2019 5:38 PM
Contacts	Authorizing Official	Update	Profile Change Request	Boggess, Richard CHIEF FINANCIAL OFFICER Morton General Hospital 3604963647	Boggess, Richard CHIEF FINANCIAL OFFICER Arbor Health 3604963647	5/31/2019 4:18 PM
Contacts	Signed By	Update	Profile Change Request	Boggess, Richard CHIEF FINANCIAL OFFICER Morton General Hospital 3604963647	Boggess, Richard CHIEF FINANCIAL OFFICER Arbor Health 3604963647	5/31/2019 4:18 PM
Addresses	Billing Address	Insert	Recertification		LEWIS COUNTY HOSPITAL DISTRICT #1 DBA MORTON GENERAL HOSPITAL PO Box 1138 Morton, WA 98356	8/27/2018 12:22 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 12:10:24 PM	8/27/2018 12:22:30 PM	8/27/2018 12:22 PM
Contacts	Primary Contact	Insert	Recertification		Garcia, Shana Executive Assistant Morton General Hospital 3604963537	11/6/2017 12:10 PM
Details	Last Recertification Date	Update	Recertification		11/6/2017 12:10:24 PM	11/6/2017 12:10 PM
Contacts	Authorizing Official	Update		Boggess, Richard CHIEF FINANCIAL OFFICER 3604963647	Boggess, Richard CHIEF FINANCIAL OFFICER Morton General Hospital 3604963647	9/20/2017 1:20 PM
Contacts	Signed By	Update		Boggess, Richard CHIEF FINANCIAL OFFICER 3604963647	Boggess, Richard CHIEF FINANCIAL OFFICER Morton General Hospital 3604963647	9/20/2017 1:20 PM
Contacts	Authorizing Official	Insert			Boggess, Richard CHIEF FINANCIAL OFFICER 3604963647	12/8/2016 1:28 PM
Contacts	Signed By	Insert			Boggess, Richard CHIEF FINANCIAL OFFICER 3604963647	12/8/2016 1:28 PM
Addresses	Main Address	Insert			745 WILLIAMS ST MOSSYROCK, WA 98564-9004	12/8/2016 1:28 PM
Dates	Participating Approval Date	Update			12/8/2016 12:00:00 AM	12/8/2016 1:27 PM
Details	State	Update		Pending	Active	12/8/2016 1:27 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	12/8/2016 1:27 PM
Details	Entity Name	Update		MORTON GENERAL HOSPITAL	LEWIS COUNTY HOSPITAL DISTRICT #1 DBA MORTON GENERAL HOSPITAL	11/29/2016 1:02 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_73288	CAH501319-02	10/31/2016 1:30 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_73288	10/14/2016 2:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/14/2016 2:44 PM
Medicaid Billing	Medicaid: Number	Insert			3081601	10/14/2016 2:44 PM
Medicaid Billing	Medicaid: State	Insert			WA	10/14/2016 2:44 PM
Medicaid Billing	NPI: Number	Insert			1184908410	10/14/2016 2:44 PM
Medicaid Billing	NPI: Number	Insert			1205882909	10/14/2016 2:44 PM
Medicaid Billing	NPI: Number	Insert			1386679777	10/14/2016 2:44 PM
Details	Last Recertification Date	Insert				10/14/2016 2:44 PM
Details	Grant Number	Insert				10/14/2016 2:44 PM
Details	340B ID	Insert				10/14/2016 2:44 PM
Details	Is Authorizing Official EHB Data	Insert				10/14/2016 2:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/14/2016 2:44 PM
Details	Medicare Provider Number	Insert			501319	10/14/2016 2:44 PM
Details	Entity Name	Insert			MORTON GENERAL HOSPITAL	10/14/2016 2:44 PM
Details	Program Code	Insert			CAH	10/14/2016 2:44 PM
Details	Entity Subname	Insert			RIFFE MEDICAL CENTER	10/14/2016 2:44 PM
Dates	Participating Approval Date	Insert				10/14/2016 2:44 PM
Details	State	Insert			Pending	10/14/2016 2:44 PM
Dates	Registration Date	Insert			10/14/2016 12:00:00 AM	10/14/2016 2:44 PM
Dates	Signed By Date	Insert			10/14/2016 12:00:00 AM	10/14/2016 2:44 PM
Dates	Start Date	Insert				10/14/2016 2:44 PM
Terminations	Termination Comments	Insert				10/14/2016 2:44 PM
Terminations	Termination Date	Insert				10/14/2016 2:44 PM
Terminations	Termination Effective Date	Insert				10/14/2016 2:44 PM
Terminations	Termination Reason	Insert				10/14/2016 2:44 PM