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CAH501309-00 Providence St Joseph's Hospital of Chewelah (Active)
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Main Details
Name
Providence St Joseph's Hospital of Chewelah
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH501309-00
Medicare Provider Number
501309
Additional Details
Current Program Status
Active
Registration Date
4/14/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/16/2014
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Providence Mt. Carmel Hospital
Ron Anthony Lawrence, Regional Director Finance Operations
(509) 474-3208
Primary Contact
Providence Health & Services - WA
Michelle Sodorff, Director, Pharmacy
(509) 474-3232
Addresses
Street Address
500 E Webster
Chewelah, WA 99109
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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