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RRC380047-00 St. Charles Health System, Inc DBA St. Charles Medical Center-Bend (Terminated)
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Main Details
Name
St. Charles Health System, Inc DBA St. Charles Medical Center-Bend
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC380047-00
Medicare Provider Number
380047
Additional Details
Current Program Status
Terminated
Registration Date
5/23/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/18/2012
Last Recertification Date
8/6/2015
Termination Date
Termination Reason
7/1/2016
Change of covered entity type
Contacts
Authorizing Official
St. Charles Health System, Inc.
Jennifer Rue Welander, Chief Financial Officer
(541) 706-7707
Primary Contact
St Charles Health System
Michael Powell, Director of Pharmacy
(541) 706-6832
Addresses
Street Address
2500 NE Neff Road
Bend, OR 97701
Billing Address
St. Charles Medical Center Bend
PO Box 6095
Bend, OR 97708-6095
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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