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CAH531310-00 Powell Valley Healthcare (Active)
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Main Details
Name
Powell Valley Healthcare
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH531310-00
Medicare Provider Number
531310
Additional Details
Current Program Status
Active
Registration Date
10/25/2011
Participating Start Date
1/1/2012
Participating Approval Date
10/28/2011
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Powell Valley Healthcare
Joy Coulston, CEO
(307) 754-1107
Primary Contact
Powell Valley Healthcare
Steven Hultgren, Pharmacy Director
(307) 754-1279
Addresses
Street Address
777 Ave H
Powell, WY 82435
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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