Covered Entity Details

CAH501339-05 WHIDBEY GENERAL HOSPITAL (Active) - information as of 5/20/2025 11:38:45 PM

Main Details

Name

WHIDBEY GENERAL HOSPITAL

Subdivision Name

WHIDBEYHEALTH - RHC Primary Care Freeland

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH501339-05

Medicare Provider Number

501339

Outpatient Facility Provider Number

508585

Additional Details

Current Program Status

Active

Registration Date

10/8/2019

Participating Start Date

1/1/2020

Participating Approval Date

11/1/2019

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

WhidbeyHealth Medical Center
Garth Allen Miller, COO
(360) 678-7656 Ext: 3802

Primary Contact

Whidbey General Hospital
Joshua Caleb Smith, Director of Pharmacy
(360) 678-7656 Ext: 3700

Addresses

Street Address

5486 HARBOR AVE
FREELAND, WA 98249-3002

Billing Address

Whidbey Island Public Hospital District
101 N MAIN ST
Inpatient Pharmacy
COUPEVILLE, WA 98239

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

Shipping Address 1

WhidbeyHealth Medical Center
101 N MAIN ST
Inpatient Pharmacy
COUPEVILLE, WA 98239

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
CAH501339-01	Child	CAH	WHIDBEY GENERAL HOSPITAL	WhidbeyHealth Primary Care - Goldie St.	1300 GOLDIE ROAD	OAK HARBOR	WA	Active
CAH501339-02	Child	CAH	WHIDBEY GENERAL HOSPITAL	WHIDBEYHEALTH PRIMARY CARE - CLINTON	11245 SR 525	CLINTON	WA	Active
CAH501339-03	Child	CAH	WHIDBEY GENERAL HOSPITAL	WHIDBEY ISLAND PUBLIC HOSPITAL DIST - RHC Primary Care - Coupeville	77 N Main St.	COUPEVILLE	WA	Active
CAH501339-04	Child	CAH	WHIDBEY GENERAL HOSPITAL	WHIDBEY ISLAND PUBLIC HOSPITAL DIST - RHC Cabot	275 SE CABOT DR STE B101	OAK HARBOR	WA	Active
CAH501339-05	Child	CAH	WHIDBEY GENERAL HOSPITAL	WHIDBEYHEALTH - RHC Primary Care Freeland	5486 HARBOR AVE	FREELAND	WA	Active
CAH501339-06	Child	CAH	WHIDBEY GENERAL HOSPITAL	WHIDBEYHEALTH HOSPICE CARE - Hospice	101 NE Birch ST	COUPEVILLE	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 1:49:27 PM	8/12/2024 11:07:41 AM	8/12/2024 11:07 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 12:51:55 PM	8/15/2023 1:49:27 PM	8/15/2023 1:49 PM
Addresses	Billing Address	Update	Change Request	Whidbey Island Public Hospital District 101 N Main Street Coupeville, WA 98239	Whidbey Island Public Hospital District 101 N MAIN ST Inpatient Pharmacy COUPEVILLE, WA 98239	6/5/2023 3:10 PM
Addresses	Shipping Address	Insert	Change Request		WhidbeyHealth Medical Center 101 N MAIN ST Inpatient Pharmacy COUPEVILLE, WA 98239	6/5/2023 3:10 PM
Details	Last Recertification Date	Update	Recertification	8/20/2021 3:57:04 PM	8/29/2022 12:51:55 PM	8/29/2022 12:51 PM
Contacts	Authorizing Official	Update	Change Request	Telles, Ronald Lawrence Chief Financial Officer WhidbeyHealth 3066787656	Miller, Garth Allen COO WhidbeyHealth Medical Center 3606787656-3802	8/22/2022 6:51 AM
Contacts	Primary Contact	Update	Group Change Request	Triplett, Tony L Director of Pharmacy Whidbey Health Medical Center 3606787656-2608	Smith, Joshua Caleb Director of Pharmacy Whidbey General Hospital 3606787656-3700	8/8/2022 10:58 AM
Details	Last Recertification Date	Update	Recertification	8/20/2020 10:53:10 AM	8/20/2021 3:57:04 PM	8/20/2021 3:57 PM
Details	Last Recertification Date	Update	Recertification		8/20/2020 10:53:10 AM	8/20/2020 10:53 AM
Contacts	Primary Contact	Update	Change Request	Triplett, Tony Director of Pharmacy, Pharmacist WhidbeyHealth 3606787656-2608	Triplett, Tony L Director of Pharmacy Whidbey Health Medical Center 3606787656-2608	3/9/2020 3:35 PM
Details	Entity Subname	Update	Change Request	WHIDBEYHEALTH WOMENS CARE - RHC Primary Care	WHIDBEYHEALTH - RHC Primary Care Freeland	2/7/2020 5:14 PM
Details	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		Telles, Ronald Lawrence Chief Financial Officer WhidbeyHealth 3066787656	11/1/2019 2:36 PM
Details	340B ID	Update	New Registration		CAH501339-05	11/1/2019 2:36 PM
Details	Entity Subname	Update	New Registration	WHIDBEYHEALTH WOMENS CARE	WHIDBEYHEALTH WOMENS CARE - RHC Primary Care	11/1/2019 2:36 PM
Dates	Participating Approval Date	Update	New Registration		11/1/2019 2:36:50 PM	11/1/2019 2:36 PM
Details	State	Update	New Registration	Pending	Approved	11/1/2019 2:36 PM
Dates	Signed By Date	Update	New Registration		10/31/2019 12:40:09 PM	11/1/2019 2:36 PM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	11/1/2019 2:36 PM
Addresses	Main Address	Insert	New Registration		5486 HARBOR AVE FREELAND, WA 98249-3002	10/8/2019 3:47 PM
Addresses	Billing Address	Insert	New Registration		Whidbey Island Public Hospital District 101 N Main Street Coupeville, WA 98239	10/8/2019 3:47 PM
Contacts	Authorizing Official	Insert	New Registration		Telles, Ronald Lawrence Chief Financial Officer WhidbeyHealth 3066787656	10/8/2019 3:47 PM
Contacts	Primary Contact	Insert	New Registration		Triplett, Tony Director of Pharmacy, Pharmacist WhidbeyHealth 3606787656-2608	10/8/2019 3:47 PM
Details	Last Recertification Date	Insert	New Registration			10/8/2019 3:47 PM
Details	Grant Number	Insert	New Registration			10/8/2019 3:47 PM
Details	340B ID	Insert	New Registration			10/8/2019 3:47 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/8/2019 3:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/8/2019 3:47 PM
Details	Medicare Provider Number	Insert	New Registration		501339	10/8/2019 3:47 PM
Details	Entity Name	Insert	New Registration		WHIDBEY GENERAL HOSPITAL	10/8/2019 3:47 PM
Details	Program Code	Insert	New Registration		CAH	10/8/2019 3:47 PM
Details	Entity Subname	Insert	New Registration		WHIDBEYHEALTH WOMENS CARE	10/8/2019 3:47 PM
Dates	Participating Approval Date	Insert	New Registration			10/8/2019 3:47 PM
Details	State	Insert	New Registration		Pending	10/8/2019 3:47 PM
Dates	Registration Date	Insert	New Registration		10/8/2019 3:47:24 PM	10/8/2019 3:47 PM
Dates	Signed By Date	Insert	New Registration			10/8/2019 3:47 PM
Dates	Start Date	Insert	New Registration			10/8/2019 3:47 PM
Terminations	Termination Comments	Insert	New Registration			10/8/2019 3:47 PM
Terminations	Termination Date	Insert	New Registration			10/8/2019 3:47 PM
Terminations	Termination Effective Date	Insert	New Registration			10/8/2019 3:47 PM
Terminations	Termination Reason	Insert	New Registration			10/8/2019 3:47 PM