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DSH380050R Sky Lakes Medical Center (Active)
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Main Details
Name
Sky Lakes Medical Center
Subdivision Name
SOUTH CASCADE SURGERY CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380050R
Medicare Provider Number
380050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/21/2016
Last Recertification Date
8/23/2024
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
2200 BRYANT WILLIAMS DR
1
KLAMATH FALLS, OR 97601-1121
Billing Address
Sky Lakes Medical Center,INC
2865 Daggett Avenue
Klamath Falls, OR 97601-1106
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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