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CAH381303-06 PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL (Active)
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Main Details
Name
PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
Subdivision Name
PROVIDENCE SEASIDE HOSPITAL / Anti Coagulation
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381303-06
Medicare Provider Number
381303
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/17/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/31/2016
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Providence Seaside Hospital
Pamela Jill Cooper, Director of Finance
(503) 717-2241
Primary Contact
Providence Health and Services
Mac Ovenell, 340B Director
(509) 860-8643
Addresses
Street Address
725 S WAHANNA RD
SEASIDE, OR 97138-7735
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
May 2025
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