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CAH501332-13 TRI-STATE MEMORIAL HOSPITAL (Active)
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Main Details
Name
TRI-STATE MEMORIAL HOSPITAL
Subdivision Name
TRI-STATE BEHAVIORAL HEALTH CLINIC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH501332-13
Medicare Provider Number
501332
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/8/2021
Participating Start Date
10/1/2021
Participating Approval Date
9/10/2021
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Tri-State Memorial Hospital
Dave Storey, Director of Pharmacy
(509) 758-5511 Ext: 5080
Primary Contact
Tri-State Memorial Hospital
Jim Heilsberg, CFO
(509) 780-4667
Addresses
Street Address
1271 HIGHLAND AVE
CLARKSTON, WA 99403
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2019; Terminated 10/1/2020; Reinstated 10/1/2021.
08/26/2021
June 2025
June 2025
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