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CAH381321-11 Grande Ronde Hospital, Inc. (Active)
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Main Details
Name
Grande Ronde Hospital, Inc.
Subdivision Name
GRANDE RONDE HOSPITAL - Dermatology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381321-11
Medicare Provider Number
381321
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/1/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/19/2019
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Grand Ronde Hospital
Robert Seymour, CFO/Senior Director of Finance
(541) 963-1463
Primary Contact
Grande Ronde Hospital
Amy A Hickey, Senior Accountant
(541) 962-2535
Addresses
Street Address
700 SUNSET DR
STE F
LA GRANDE, OR 97850-1260
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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