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CAH381317-06 NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER
Subdivision Name
TILLAMOOK REGIONAL MEDICAL CENTER - Long Prairie Clinic (primary care)
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381317-06
Medicare Provider Number
381317
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/13/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/24/2018
Last Recertification Date
8/28/2024
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
5995 LONG PRAIRIE RD
TILLAMOOK, OR 97141-9689
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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