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CAH501323-01 JEFFERSON HEALTHCARE (Active)
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Main Details
Name
JEFFERSON HEALTHCARE
Subdivision Name
South County Medical Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH501323-01
Medicare Provider Number
501323
Outpatient Facility Provider Number
503997
Additional Details
Current Program Status
Active
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/19/2016
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Jefferson Healthcare
Jacob Bujacich Davidson, Chief Operating Officer
(360) 385-2200 Ext: 2039
Primary Contact
Jefferson Healthcare
Andrew John Nelson, Director of Pharmacy
(360) 385-2200 Ext: 2345
Addresses
Street Address
294843 US HWY 101
SOUTH COUNTY MEDICAL CLINIC
QUILCENE, WA 98376-9800
Billing Address
Jefferson Healthcare Pharmacy
834 Sheridan St
Port Townsend, WA 98368
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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