Covered Entity Details

CAH381314-06 SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL (Active) - information as of 5/20/2025 11:40:20 PM

Main Details

Name

SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL

Subdivision Name

SPCH Hemotology and Oncology Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381314-06

Medicare Provider Number

381314

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/3/2012

Participating Start Date

1/1/2013

Participating Approval Date

10/31/2012

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

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

Primary Contact

Samaritan Lebanon Community Hospital
Daniel Rackham, Chief Executive Officer
(541) 451-7914

Addresses

Street Address

930 SW Abbey Street
Newport, OR 97365

Billing Address

Samaritan Health Services, Inc.
PO BOX 3000
Corvallis, OR 97339

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	500786269,268916	1801847066,1578813903

Shipping Addresses

Shipping Address 1

SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL
930 SW Abbey
Newport, OR 97365

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
CAH381314-01	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	PCH WALK-IN CLINIC	930 SW Abbey Street Suite F	Newport	OR	Terminated
CAH381314-02	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SPCH Toledo Clinic	199 West Hwy 20	Toledo	OR	Active
CAH381314-03	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SPCH Depoe Bay Clinic	531 N Highway 101 Suite A	Depoe Bay	OR	Active
CAH381314-04	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SPCH Waldport Clinic	920 SW Range Drive	Waldport	OR	Active
CAH381314-05	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SPCH Orthopedic Clinic	930 SW Abbey Street Ste B	Newport	OR	Active
CAH381314-06	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SPCH Hemotology and Oncology Clinic	930 SW Abbey Street	Newport	OR	Active
CAH381314-07	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	Samaritan Pacific Women's Health Group	930 SW Abbey Street Ste B	Newport	OR	Active
CAH381314-08	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	Samaritan Pacific Surgical Associates	930 SW Abbey Street Ste B	Newport	OR	Active
CAH381314-09	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	PCH Sam Newport Health Ctr - RHC	930 SW Abbey Street Ste A	Newport	OR	Active
CAH381314-10	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	PCH Medication Management - Newport	930 SW Abbey Street Suite B	NEWPORT	OR	Active
CAH381314-11	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SPC Hospice Outpatient	749 SW 11th Street	Newport	OR	Terminated
CAH381314-12	Child	CAH	SAMARITAN PACIFIC COMM HOSPIAL	SAMARITAN INFECTION DISEASE-DEPOE B	531 NW HWY 101	DEPOE BAY	OR	Terminated
CAH381314-13	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SAMARITAN CENTRAL COAST INTERNAL MEDICINE	930 SW Abbey Street Ste A	NEWPORT	OR	Terminated
CAH381314-14	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SAMARITAN CARDIOLOGY-NEWPORT	930 SW Abbey Street, Suite B	Newport	OR	Active
CAH381314-15	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	PCH Urology - Urology	930 SW Abbey Street Ste B	Newport	OR	Active
CAH381314-16	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	PCH Kidney Specialist - Kidney	531 N Hwy 101, Suite A	Depoe Bay	OR	Active
CAH381314-17	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	PCH Walk In Clinic - PCH Walk In Clinic	705 SW Coast Hwy	Neport	OR	Active
CAH381314-18	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	PCH Endocrinology - PCH Endocrinology	930 SW Abbey Street, Suite B	Newport	OR	Active
CAH381314-19	Child	CAH	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	PCH Diabetes Management - PCH Diabetes Management	930 SW Abbey Street	Newport	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Rackham, Daniel Chief Executive Officer Samaritan Lebanon Community Hospital 5414517107	Rackham, Daniel Chief Executive Officer Samaritan Lebanon Community Hospital 5414517914	10/9/2024 10:28 AM
Contacts	Primary Contact	Update	Profile Change Request	Rackham, Daniel Chief Pharmacy Officer Samaritan Health Services 5417686177	Rackham, Daniel Chief Executive Officer Samaritan Lebanon Community Hospital 5414517107	10/8/2024 1:41 PM
Details	Last Recertification Date	Update	Recertification	8/28/2023 6:12:52 PM	8/23/2024 3:32:41 PM	8/23/2024 3:32 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 2:56:35 PM	8/28/2023 6:12:52 PM	8/28/2023 6:12 PM
Details	Last Recertification Date	Update	Recertification	8/20/2021 6:04:35 PM	8/30/2022 2:56:35 PM	8/30/2022 2:56 PM
Contacts	Primary Contact	Update	Change Request	Douglas, Joy R Rx data Coordinator - 340B Contract Pharmacy Samaritan Health Services 5417686867	Rackham, Daniel Chief Pharmacy Officer Samaritan Health Services 5417686177	1/12/2022 7:14 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/20/2021 6:04 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		500786269	8/20/2021 6:04 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		OR	8/20/2021 6:04 PM
Details	Last Recertification Date	Update	Recertification	9/8/2020 3:36:18 PM	8/20/2021 6:04:35 PM	8/20/2021 6:04 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1376691345 ( )		9/8/2020 3:36 PM
Medicaid Billing	NPI: State	Update	Recertification		OR	9/8/2020 3:36 PM
Medicaid Billing	NPI: State	Update	Recertification		OR	9/8/2020 3:36 PM
Details	Last Recertification Date	Update	Recertification	9/3/2019 3:42:56 PM	9/8/2020 3:36:18 PM	9/8/2020 3:36 PM
Addresses	Billing Address	Update	Change Request	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL 930 SW Abbey Newport, OR 97365	Samaritan Health Services, Inc. PO BOX 3000 Corvallis, OR 97339	8/6/2020 6:50 PM
Contacts	Primary Contact	Update	Change Request	Reher, Penny Chief Pharmacy Officer Good Samaritan Regional Medical Center 5417686177	Douglas, Joy R Rx data Coordinator - 340B Contract Pharmacy Samaritan Health Services 5417686867	8/6/2020 6:50 PM
Addresses	Billing Address	Insert	Change Request		SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL 930 SW Abbey Newport, OR 97365	4/22/2020 6:18 PM
Addresses	Shipping Address	Insert	Change Request		SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL 930 SW Abbey Newport, OR 97365	4/22/2020 6:18 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1376691345	3/11/2020 11:52 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1578813903	3/11/2020 11:52 AM
Details	Last Recertification Date	Update	Recertification	8/28/2018 5:50:01 PM	9/3/2019 3:42:56 PM	9/3/2019 3:42 PM
Details	Last Recertification Date	Update	Recertification	11/17/2017 6:04:37 PM	8/28/2018 5:50:01 PM	8/28/2018 5:50 PM
Details	Entity Name	Update	Recertification	SAMARITAN PACIFIC HEALTH SYSTEMS, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	11/18/2017 12:12 PM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/17/2017 6:04:37 PM	11/17/2017 6:04 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			930 SW Abbey Street Newport, OR 97365	7/19/2017 5:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/19/2017 5:28 PM
Medicaid Billing	Medicaid: Number	Insert			268916	7/19/2017 5:28 PM
Medicaid Billing	Medicaid: State	Insert			OR	7/19/2017 5:28 PM
Medicaid Billing	NPI: Number	Insert			1801847066	7/19/2017 5:28 PM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 7:53 PM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	8/31/2015 12:00:00 AM	8/31/2015 4:16 PM
Details	Last Recertification Date	Update		9/6/2013 8:07:14 PM	8/27/2014 12:00:00 AM	8/27/2014 12:44 PM
Details	Last Recertification Date	Update			9/6/2013 8:07:14 PM	9/6/2013 8:07 PM
Details	340B ID	Update		ISDMCAH381314-06	CAH381314-06	10/31/2012 5:14 PM
Dates	Participating Approval Date	Update			10/31/2012 12:00:00 AM	10/31/2012 5:14 PM
Details	State	Update		Pending	Active	10/31/2012 5:14 PM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	10/31/2012 5:14 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISDMCAH381314-06	10/26/2012 4:04 PM
Details	Last Recertification Date	Insert				10/3/2012 6:06 PM
Details	Grant Number	Insert				10/3/2012 6:06 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/3/2012 6:06 PM
Details	Is Authorizing Official EHB Data	Insert				10/3/2012 6:06 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/3/2012 6:06 PM
Details	Medicare Provider Number	Insert			381314	10/3/2012 6:06 PM
Details	Entity Name	Insert			SAMARITAN PACIFIC HEALTH SYSTEMS, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	10/3/2012 6:06 PM
Details	Program Code	Insert			CAH	10/3/2012 6:06 PM
Details	Entity Subname	Insert			SPCH Hemotology and Oncology Clinic	10/3/2012 6:06 PM
Dates	Participating Approval Date	Insert				10/3/2012 6:06 PM
Details	State	Insert			Pending	10/3/2012 6:06 PM
Dates	Registration Date	Insert			10/3/2012 12:00:00 AM	10/3/2012 6:06 PM
Dates	Signed By Date	Insert			10/3/2012 12:00:00 AM	10/3/2012 6:06 PM
Dates	Start Date	Insert				10/3/2012 6:06 PM
Terminations	Termination Comments	Insert				10/3/2012 6:06 PM
Terminations	Termination Date	Insert				10/3/2012 6:06 PM
Terminations	Termination Effective Date	Insert				10/3/2012 6:06 PM
Terminations	Termination Reason	Insert				10/3/2012 6:06 PM