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CAH501338-01 PUBLIC HOSPITAL DISTRICT #4 KING COUNTY WASHINGTON (Active)
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Main Details
Name
PUBLIC HOSPITAL DISTRICT #4 KING COUNTY WASHINGTON
Subdivision Name
PUBLIC HOSPITAL DISTRICT NO 4 KING - Family Medicine
Type
Critical Access Hospital
Rural
No
340B ID
CAH501338-01
Medicare Provider Number
501338
Outpatient Facility Provider Number
508580
Additional Details
Current Program Status
Active
Registration Date
7/10/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/3/2019
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Snoqualmie Valley Health
Jeremy Storm, CMO
(425) 414-9034
Primary Contact
Snoqualmie Valley Hospital
RON E BENNETT, PHARMACY DIRECTOR
(425) 831-3407
Addresses
Street Address
35020 SE KINSEY ST Suite A
SNOQUALMIE, WA 98065-9086
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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