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CAH501320-00 QUINCY VALLEY MEDICAL CENTER (Terminated)
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Main Details
Name
QUINCY VALLEY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH501320-00
Medicare Provider Number
501320
Additional Details
Current Program Status
Terminated
Registration Date
1/3/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/21/2017
Last Recertification Date
11/17/2017
Termination Date
Termination Reason
10/1/2018
Failure to recertify
Contacts
Authorizing Official
Grant Public Hospital District 2
Marissa Villela, CNO
(509) 787-3531 Ext: 5398
Primary Contact
QUINCY VALLEY MEDICAL CENTER
Tom Richardson, DIRECTOR OF INFORMATION SYSTEMS
(509) 787-5357
Addresses
Street Address
908 10TH AVENUE SW
QUINCY, WA 98848
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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