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RRC500039-14 ST. MICHAEL MEDICAL CENTER (Active)
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Main Details
Name
ST. MICHAEL MEDICAL CENTER
Subdivision Name
ST. MICHAEL MEDICAL CENTER - Port Orchard Urgent Care
Type
Rural Referral Center
Rural
No
340B ID
RRC500039-14
Medicare Provider Number
500039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/21/2018
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
450 S KITSAP BLVD STE 100
PORT ORCHARD, WA 98366-3709
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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April 2025
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