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CAH031300-00 WICKENBURG COMMUNITY HOSPITAL ASSOCIATION INC (Active)
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Main Details
Name
WICKENBURG COMMUNITY HOSPITAL ASSOCIATION INC
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH031300-00
Medicare Provider Number
031300
Additional Details
Current Program Status
Active
Registration Date
2/22/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/15/2012
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Wickenburg Community Hospital
Jackie S Lundblad, CEO
(602) 321-8402
Primary Contact
Wickenburg Community Hospital
Brian Schuele, Director of Pharmacy
(928) 684-4380
Addresses
Street Address
520 ROSE LANE
WICKENBURG, AZ 85390
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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February 2025
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