340B Drug Pricing Program Database
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RRC500039-02 ST. MICHAEL MEDICAL CENTER (Terminated)
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Main Details
Name
ST. MICHAEL MEDICAL CENTER
Subdivision Name
St. Michael Medical Center - Cancer Center Infusion Clinic
Type
Rural Referral Center
Rural
No
340B ID
RRC500039-02
Medicare Provider Number
500039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/27/2017
Last Recertification Date
8/28/2020
Termination Date
Termination Reason
7/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
CHI Franciscan Health
David Butcherite, CFO
(253) 680-4031
Primary Contact
St. Michael Medical Center (formerly Harrison Medical Center)
Charles C Ho, Director of Pharmacy
(714) 658-2517
Addresses
Street Address
1900 NW Myhre Road
Silverdale, WA 98383
Billing Address
St Michael Medical Center
1800 NW Myhre Road
Silverdale, WA 98383
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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