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DSH120006A CASTLE MEDICAL CENTER (Terminated)
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Main Details
Name
CASTLE MEDICAL CENTER
Subdivision Name
Castle Medical Center OP Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH120006A
Medicare Provider Number
120006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/2/2013
Last Recertification Date
8/17/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Adventist Health And Rideout
Heidar Thordarson, VP Finance / CFO
(530) 751-4012
Primary Contact
Adventist Health Castle
Douglas E. Duncan, DIRECTOR OF PHARMACY
(808) 263-5192
Addresses
Street Address
642 Ulukahiki Street Suite 103
Kailua, HI 96734
Billing Address
Castle Medical Center
640 Ulukahiki Street
Kailua, HI 96734
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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