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SCH380001-03 MID-COLUMBIA MEDICAL CENTER (Terminated)
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Main Details
Name
MID-COLUMBIA MEDICAL CENTER
Subdivision Name
MID-COLUMBIA MEDICAL CENTER-INTERNAL MEDICINE RURAL HEALTH CLINIC
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH380001-03
Medicare Provider Number
380001
Outpatient Facility Provider Number
383997
Additional Details
Current Program Status
Terminated
Registration Date
9/28/2010
Participating Start Date
9/28/2010
Participating Approval Date
9/28/2010
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Mid-Columbia Medical Center
DENNIS KNOX, CEO
(541) 296-7272
Primary Contact
DONALD ARBON, V.P. FINANCE/CFO
(541) 296-7524
Addresses
Street Address
1815 E 19TH STREET
THE DALLES, OR 97058
Billing Address
MID-COLUMBIA MEDICAL CENTER
P O BOX 1520
THE DALLES, OR 97058
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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