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CAH501339-01 WHIDBEY GENERAL HOSPITAL (Active)
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Main Details
Name
WHIDBEY GENERAL HOSPITAL
Subdivision Name
WhidbeyHealth Primary Care - Goldie St.
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH501339-01
Medicare Provider Number
501339
Outpatient Facility Provider Number
503996
Additional Details
Current Program Status
Active
Registration Date
10/8/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/16/2019
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
1300 GOLDIE ROAD
OAK HARBOR, WA 98277
Billing Address
WHIDBEY GENERAL HOSPITAL
101 NORTH MAIN STREET
COUPEVILLE, WA 98239
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (9/27/2010) until terminated effective date: (01/01/2018), reinstatement effective date: (01/01/2020)
10/15/2019
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