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CAH501332-11 TRI-STATE MEMORIAL HOSPITAL (Active)
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Main Details
Name
TRI-STATE MEMORIAL HOSPITAL
Subdivision Name
Tri-State Interventional Pain Consultants
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH501332-11
Medicare Provider Number
501332
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/16/2017
Participating Start Date
4/1/2017
Participating Approval Date
1/17/2017
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Tri-State Memorial Hospital
Dave Storey, Director of Pharmacy
(509) 758-5511 Ext: 5080
Primary Contact
Tri-State Memorial Hospital
Jim Heilsberg, CFO
(509) 780-4667
Addresses
Street Address
1119 Highland Avenue Suite 11
Interventional Pain Consultants
Clarkston, WA 99403
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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