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CAH051320-00 BANNER LASSEN MEDICAL CENTER (Active)
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Main Details
Name
BANNER LASSEN MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH051320-00
Medicare Provider Number
051320
Additional Details
Current Program Status
Active
Registration Date
9/3/2010
Participating Start Date
9/20/2010
Participating Approval Date
9/20/2010
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Washakie Medical Center
Jennifer McMillan, Chief Financial Officer
(307) 347-6940
Primary Contact
Banner Lassen Medical Center
Abby Adesanya, Director of Pharmacy
(530) 252-2160
Addresses
Street Address
1800 SPRING RIDGE DRIVE
SUSANVILLE, CA 96130
Billing Address
Banner Health Accounts Payable
PO Box 2977
Phoenix, AZ 85062
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/28/2011- DOC.RECD. TO CONFIRM NON-PROFIT STATUS
07/06/2011
April 2025
April 2025
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