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CAH531305-02 PLATTE COUNTY HOSPITAL (Active)
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Main Details
Name
PLATTE COUNTY HOSPITAL
Subdivision Name
BANNER MEDICAL CLINIC WHEATLAND - Family Practice Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH531305-02
Medicare Provider Number
531305
Outpatient Facility Provider Number
533995
Additional Details
Current Program Status
Active
Registration Date
7/16/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/30/2018
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Washakie Medical Center
Jennifer McMillan, Chief Financial Officer
(307) 347-6940
Primary Contact
Platte County Memorial Hospital
Mark T Schmick, Associate Director of Pharmacy
(307) 322-8220
Addresses
Street Address
201 14th Street
Annex Building
WHEATLAND, WY 82201-3505
Billing Address
Banner Health Accounts Payable
PO Box 2977
Phoenix, AZ 85062
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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