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DSH380050T SKY LAKES MEDICAL CENTER (Terminated)
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Main Details
Name
SKY LAKES MEDICAL CENTER
Subdivision Name
Primary Care Clinic on Almond
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380050T
Medicare Provider Number
380050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/21/2016
Last Recertification Date
Termination Date
Termination Reason
7/1/2016
Other
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
2617 Almond Street
Klamath Falls, OR 97601
Billing Address
Sky Lakes Medical Center, Inc
2865 Daggett Avenue
Klamath Falls, OR 97601-1106
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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