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CAH381301-00 COTTAGE GROVE COMMUNITY HOSPITAL (Active)
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Main Details
Name
COTTAGE GROVE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH381301-00
Medicare Provider Number
381301
Additional Details
Current Program Status
Active
Registration Date
1/17/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/14/2017
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
PeaceHealth Peace Harbor Medical Center
Jason Hawkins, Chief Administrive Officer
(541) 902-6540
Primary Contact
PeaceHealth
Adriane Kindell, 340B System Program Supervisor
(360) 414-2137
Addresses
Street Address
1515 VILLAGE DRIVE
COTTAGE GROVE, OR 97424-9700
Billing Address
PEACEHEALTH
1115 SE 164th Ave
332
Vancouver, WA 98683
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated started 7/1/11; Terminated on 10/1/16; Reinstated starting 4/1/17.
03/14/2017
3/6/12 - Deleted medicaid # (was 237519)
03/06/2012
May 2025
May 2025
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