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SCH270051-53 KALISPELL REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
KALISPELL REGIONAL MEDICAL CENTER
Subdivision Name
POLSON PROCEDURES - AMBULATORY SURGICAL CENTER
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH270051-53
Medicare Provider Number
270051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/6/2019
Last Recertification Date
8/23/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Kalispell Regional Healthcare
Craig O Boyer, Chief Financial Officer
(406) 752-5111
Primary Contact
Kalispell Regional Medical Center
Tera Thorderson, Pharmacist
(406) 607-8004
Addresses
Street Address
106 Ridgewater Drive, Suite B
Polson, MT 59860
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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