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CAH021311-00 PEACEHEALTH D/B/A KETCHIKAN MEDICAL CENTER (Active)
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Main Details
Name
PEACEHEALTH D/B/A KETCHIKAN MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH021311-00
Medicare Provider Number
021311
Additional Details
Current Program Status
Active
Registration Date
5/27/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/15/2011
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Peacehealth.org
Krista N Touros, CFO
(360) 788-6754 Ext: 6754
Primary Contact
PeaceHealth
Adriane Kindell, 340B Program Supervisor
(360) 414-2137
Addresses
Street Address
3100 TONGASS AVE
KETCHIKAN, AK 99901
Billing Address
PeaceHealth
1115 SE 164th Ave, Ste 332
Vancouver, WA 98683
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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