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DSH380050W Sky Lakes Medical Center (Active)
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Main Details
Name
Sky Lakes Medical Center
Subdivision Name
SKY LAKES UROLOGY - B
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380050W
Medicare Provider Number
380050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/9/2019
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Sky Lakes Medical Center
Richard E. Rico, Vice President/CFO
(541) 274-6150
Primary Contact
Sky Lakes Medical Center
Mychal Amos, Director of Pharmacy Services
(541) 274-3799
Addresses
Street Address
2200 BRYANT WILLIAMS DRIVE
#5
KLAMATH FALLS, OR 97601
Billing Address
SKY LAKES MEDICAL CENTER INC
2865 DAGGETT AVENUE
KLAMATH FALLS, OR 97601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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