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CAH381317-08 NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
NORTHWEST MEDICAL FOUNDATION OF TILLAMOOK D/B/A TILLAMOOK REGIONAL MEDICAL CENTER
Subdivision Name
NORTHWEST MEDICAL FOUNDATION OF TIL - Medical Office - Estacada
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381317-08
Medicare Provider Number
381317
Outpatient Facility Provider Number
388533
Additional Details
Current Program Status
Active
Registration Date
10/15/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/19/2020
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Adventist Health Tillamook
Heather Thompson, Patient Care Executive
(503) 815-2258
Primary Contact
Tillamook Regional Medical Center
KYLE CONNAUGHTON, PHARMACY DIRECTOR
(503) 815-2260
Addresses
Street Address
200 SE HIGHWAY 224
STE 100
ESTACADA, OR 97023-7022
Billing Address
Adventist Health Tillamook
PO Box 458
Medical Office - Estacada
Tillamook, OR 97141
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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