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CAH381317-10 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 - Vernonia
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381317-10
Medicare Provider Number
381317
Outpatient Facility Provider Number
388547
Additional Details
Current Program Status
Active
Registration Date
4/14/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/18/2023
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
1005 COUGAR ST
VERNONIA, OR 97064-1282
Billing Address
Adventist Health Vernonia
PO Box 458
Tillamook, OR 97141
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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