340B Drug Pricing Program Database
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DSH380050F Sky Lakes Medical Center (Terminated)
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Main Details
Name
Sky Lakes Medical Center
Subdivision Name
SKY LAKES KLAMATH MEDICAL CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380050F
Medicare Provider Number
380050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/28/2015
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Sky Lakes Medical Center
Richard E. Rico, Vice President/CFO
(541) 274-6150
Primary Contact
Sky Lakes Medical Center
Mychal Amos, Director of Pharmacy Services
(541) 274-3799
Addresses
Street Address
2821 Daggett Avenue
200
Klamath Falls, OR 97601-1106
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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