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CAH381317-05 NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER
Subdivision Name
AH Lincoln City - RHC (AHTM)
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381317-05
Medicare Provider Number
381317
Outpatient Facility Provider Number
388516
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/25/2017
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Adventist Health Tillamook
Heather Thompson, Patient Care Executive
(503) 815-2258
Primary Contact
Tillamook Regional Medical Center
KYLE CONNAUGHTON, PHARMACY DIRECTOR
(503) 815-2260
Addresses
Street Address
1105 SE JETTY AVE STE C
ADVENTIST HEALTH BAYSHORE MEDICAL-LINCOLN CITY
LINCOLN CITY, OR 97367-2604
Billing Address
Tillamook Regional Medical Center
1000 third st
Tillamook, OR 97141
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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