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RRC500039-03 ST. MICHAEL MEDICAL CENTER (Active)
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Main Details
Name
ST. MICHAEL MEDICAL CENTER
Subdivision Name
ST. MICHAEL MEDICAL CENTER - Infusion Center (Optimum)
Type
Rural Referral Center
Rural
No
340B ID
RRC500039-03
Medicare Provider Number
500039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/12/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/7/2017
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Virginia Mason Franciscan Health
David Nosacka, SVP and CFO
(253) 680-4005
Primary Contact
Virginia Mason Franciscan Health
Paul Wallace, Oncology Pharmacy Supervisor
(564) 240-3311
Addresses
Street Address
742 LEBO BLVD STE A
BREMERTON, WA 98310-3325
Billing Address
ST. MICHAEL MEDICAL CENTER
PO BOX 636000
LITTLETON, CO 80163-6000
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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