Covered Entity Details

CAH381323-03 MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL (Terminated) - information as of 4/30/2025 10:48:41 PM

Main Details

Name

MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL

Subdivision Name

Samaritan Cardiology

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381323-03

Medicare Provider Number

381323

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/3/2012

Participating Start Date

1/1/2013

Participating Approval Date

10/18/2012

Last Recertification Date

8/28/2018

Termination Date
Termination Reason

7/1/2019
Site closure

Contacts

Authorizing Official

Samaritan Health Services
Daniel Smith, VP Finance/CFO
(541) 768-5390

Primary Contact

Good Samaritan Regional Medical Center
Penny Reher, Chief Pharmacy Officer
(541) 768-6177

Addresses

Street Address

425 North Santiam Highway
Lebanon, OR 97355

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
OR	500652027,500651644
		1689625980,1891059135

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH381323-01	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	Samaritan Hemotology and Oncology Consultants	525 North Santiam Highway	Lebanon	OR	Terminated
CAH381323-02	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Sweet Home Family Medicine	1289 49th Avenue	Sweet Home	OR	Active
CAH381323-03	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	Samaritan Cardiology	425 North Santiam Highway	Lebanon	OR	Terminated
CAH381323-04	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Brownsville Family Medicine	157 Spaulding Avenue	Brownsville	OR	Active
CAH381323-05	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Mid-Valley Medical Plaza	425 North Santiam Hwy	Lebanon	OR	Terminated
CAH381323-06	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH ER Physicians	525 North Santiam Highway	Lebanon	OR	Terminated
CAH381323-07	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Main Street Family Medicine	191 North Main Street	Lebanon	OR	Active
CAH381323-08	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Park Street Clinic	325 Park Street	Lebanon	OR	Active
CAH381323-09	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	Samaritan Orthopedic and Sports Medicine	100 Mullins Drive Suite D-3	Lebanon	OR	Terminated
CAH381323-10	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	SLCH Urgent Care	35 Mullins Drive Suite 2	Lebanon	OR	Active
CAH381323-11	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Fam Med Residency Clinic	425 N SANTIAM HWY	LEBANON	OR	Active
CAH381323-12	Child	CAH	SAMARITAN LEBANON COMM HOSPITAL	Urology	525 North Santiam Highway	Lebanon	OR	Terminated
CAH381323-13	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Medication Management - Lebanon	425 North Santiam Highway	Lebanon	OR	Active
CAH381323-14	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH WOUND CARE	679 Main Street	Sweet Home	OR	Terminated
CAH381323-15	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	MID-VALLEY HEALTHCARE, INC. / LCH Anticoag A Park Street	325 PARK ST	LEBANON	OR	Terminated
CAH381323-18	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Medication Management - Sweet Home	1289 49th Avenue	Sweet Home	OR	Active
CAH381323-19	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	Mid valley Healthcare, inc. DBA Samaritan Lebanon Community Hospital - LCH Sam Lebanon Health Ctr	675 North 5th St Suite 200	Lebanon	OR	Active
CAH381323-20	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Health Center - Pediatrics - LCH Health Center - Pediatrics	675 North 5th St Suite 200	Lebanon	OR	Active
CAH381323-21	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Samaritan Fam Med SLHC - LCH Samaritan Fam Med SLHC	675 North 5th St Suite 200	Lebanon	OR	Active
CAH381323-22	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Health Center - OB-GYN - LCH Health Center - OB-GYN	675 North 5th St Suite 200	Lebanon	OR	Active
CAH381323-23	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Diabetes Management - LCH Diabetes Management	525 N. Santiam Hwy	Lebanon	OR	Active
CAH381323-24	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH Hematology & Oncology - LCH - Hematology & Oncology	525 N Santiam Hwy	Lebanon	OR	Active
CAH381323-25	Child	CAH	MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	LCH SH Urgent Care WI RHC - LCH - Urgent Care	1289 49th Avenue	Sweet Home	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		3/31/2019 12:00:00 AM	5/3/2019 10:16 AM
Details	State	Update	Termination Request	Active	To Be Terminated	5/3/2019 10:16 AM
Terminations	Termination Date	Update	Termination Request		7/1/2019 12:00:00 AM	5/3/2019 10:16 AM
Terminations	Termination Effective Date	Update	Termination Request		4/1/2019 12:00:00 AM	5/3/2019 10:16 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	5/3/2019 10:16 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/17/2018 3:24 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		500652027	12/17/2018 3:24 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OR	12/17/2018 3:24 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1891059135	12/17/2018 3:24 PM
Details	Last Recertification Date	Update	Recertification	11/17/2017 6:10:00 PM	8/28/2018 5:47:31 PM	8/28/2018 5:47 PM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/17/2017 6:10:00 PM	11/17/2017 6:10 PM
Contacts	Authorizing Official	Update		Smith, Daniel VP Finance/CFO 5417685390	Smith, Daniel VP Finance/CFO Samaritan Health Services 5417685390	10/23/2017 2:51 PM
Contacts	Primary Contact	Update		Reher, Penny Chief Pharmacy Officer 5417686177	Reher, Penny Chief Pharmacy Officer Good Samaritan Regional Medical Center 5417686177	10/9/2017 2:48 PM
Contacts	Signed By	Update		Reher, Penny Chief Pharmacy Officer 5417686177	Reher, Penny Chief Pharmacy Officer Good Samaritan Regional Medical Center 5417686177	10/9/2017 2:48 PM
Contacts	Primary Contact	Insert			Reher, Penny Chief Pharmacy Officer 5417686177	7/28/2017 6:33 PM
Contacts	Signed By	Insert			Reher, Penny Chief Pharmacy Officer 5417686177	7/28/2017 6:33 PM
Contacts	Authorizing Official	Insert			Smith, Daniel VP Finance/CFO 5417685390	7/28/2017 6:33 PM
Addresses	Main Address	Insert			425 North Santiam Highway Lebanon, OR 97355	7/27/2017 5:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/19/2017 5:11 PM
Medicaid Billing	Medicaid: Number	Insert			500651644	7/19/2017 5:11 PM
Medicaid Billing	Medicaid: State	Insert			OR	7/19/2017 5:11 PM
Medicaid Billing	NPI: Number	Insert			1689625980	7/19/2017 5:11 PM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 7:58 PM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	8/31/2015 12:00:00 AM	8/31/2015 4:37 PM
Details	Last Recertification Date	Update		9/6/2013 8:03:05 PM	8/27/2014 12:00:00 AM	8/27/2014 12:36 PM
Details	Last Recertification Date	Update			9/6/2013 8:03:05 PM	9/6/2013 8:03 PM
Details	340B ID	Update		IS-JM-CAH381323-03	CAH381323-03	10/18/2012 11:21 AM
Dates	Participating Approval Date	Update			10/18/2012 12:00:00 AM	10/18/2012 11:21 AM
Details	State	Update		Pending	Active	10/18/2012 11:21 AM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	10/18/2012 11:21 AM
Details	340B ID	Update		IS-CAH381323-02	IS-JM-CAH381323-03	10/16/2012 4:11 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-CAH381323-02	10/16/2012 4:08 PM
Details	Last Recertification Date	Insert				10/3/2012 1:24 PM
Details	Grant Number	Insert				10/3/2012 1:24 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/3/2012 1:24 PM
Details	Is Authorizing Official EHB Data	Insert				10/3/2012 1:24 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/3/2012 1:24 PM
Details	Medicare Provider Number	Insert			381323	10/3/2012 1:24 PM
Details	Entity Name	Insert			MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL	10/3/2012 1:24 PM
Details	Program Code	Insert			CAH	10/3/2012 1:24 PM
Details	Entity Subname	Insert			Samaritan Cardiology	10/3/2012 1:24 PM
Dates	Participating Approval Date	Insert				10/3/2012 1:24 PM
Details	State	Insert			Pending	10/3/2012 1:24 PM
Dates	Registration Date	Insert			10/3/2012 12:00:00 AM	10/3/2012 1:24 PM
Dates	Signed By Date	Insert			10/3/2012 12:00:00 AM	10/3/2012 1:24 PM
Dates	Start Date	Insert				10/3/2012 1:24 PM
Terminations	Termination Comments	Insert				10/3/2012 1:24 PM
Terminations	Termination Date	Insert				10/3/2012 1:24 PM
Terminations	Termination Effective Date	Insert				10/3/2012 1:24 PM
Terminations	Termination Reason	Insert				10/3/2012 1:24 PM