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CAH381306-03 Wallowa County Health Care District DBA Wallowa Memorial Hospital (Active)
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Main Details
Name
Wallowa County Health Care District DBA Wallowa Memorial Hospital
Subdivision Name
Wallowa Memorial Medical Clinic - Wallowa - Rural Health Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381306-03
Medicare Provider Number
381306
Outpatient Facility Provider Number
388552
Additional Details
Current Program Status
Active
Registration Date
7/5/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/6/2022
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Wallowa County Health Care District
Nathan Hiebert, CFO
(541) 426-5460
Primary Contact
Wallowa Memorial Hospital
Edward Scott Tarter, Director of Pharmacy
(541) 426-5451
Addresses
Street Address
701 W Hwy 82
Wallowa, OR 97885
Billing Address
Wallowa County Health Care District
601 Medical Parkway
Enterprise, OR 97828
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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