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CAH501337-06 LOURDES MEDICAL CENTER (Terminated)
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Main Details
Name
LOURDES MEDICAL CENTER
Subdivision Name
Lourdes West Pasco / Surgical and Breast Care Center
Type
Critical Access Hospital
Rural
No
340B ID
CAH501337-06
Medicare Provider Number
501337
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/20/2015
Last Recertification Date
11/13/2017
Termination Date
Termination Reason
10/1/2018
For-Profit conversion
Contacts
Authorizing Official
Lourdes Medical Center
FRANK R BECKER, CFO
(509) 546-2282
Primary Contact
Lourdes Medical Center
Tracy Sue Clark, Director of Pharmacy
(509) 546-2298
Addresses
Street Address
7425 Wrigley Drive Ste 204
Pasco, WA 99301
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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