Covered Entity Details

DSH380056F SANTIAM MEMORIAL HOSPITAL (Active) - information as of 6/26/2025 12:25:28 AM

Main Details

Name

SANTIAM MEMORIAL HOSPITAL

Subdivision Name

SANTIAM MEMORIAL HOSPITAL - Cascade Medical Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH380056F

Medicare Provider Number

380056

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/14/2021

Participating Start Date

7/1/2021

Participating Approval Date

4/19/2021

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Santiam Memorial Hospital
Maggie Ann Hudson, CEO
(503) 769-9236

Primary Contact

Santiam Memorial Hospital
Tiffanie Ann Pye, Chief Operations Officer
(503) 769-2852

Addresses

Street Address

1369 N 10TH AVE
STAYTON, OR 97383

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating Start Date 7/1/2020, Termination 10/1/2020, Reinstatement 7/1/2021	04/19/2021

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		1790171874

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
DSH380056A	Child	DSH	SANTIAM MEMORIAL HOSPITAL	SANTIAM MEMORIAL HOSPITAL - Santiam Medical Associates	1401 N 10TH AVE	STAYTON	OR	Active
DSH380056B	Child	DSH	SANTIAM MEMORIAL HOSPITAL	SANTIAM MEMORIAL HOSPITAL - Santiam Hospital Outpatient Treatment Services	1401 N 10TH AVE	STAYTON	OR	Active
DSH380056C	Child	DSH	SANTIAM MEMORIAL HOSPITAL	SANTIAM MEMORIAL HOSPITAL - Sublimity Medical Clinic	114 SE CHURCH ST	SUBLIMITY	OR	Active
DSH380056D	Child	DSH	SANTIAM MEMORIAL HOSPITAL	SANTIAM MEMORIAL HOSPITAL - Aumsville Medical Clinic	205 MAIN ST	AUMSVILLE	OR	Active
DSH380056E	Child	DSH	SANTIAM MEMORIAL HOSPITAL	SANTIAM MEMORIAL HOSPITAL - Santiam Internal Medicine Clinic	1401 N 10TH AVE	STAYTON	OR	Active
DSH380056F	Child	DSH	SANTIAM MEMORIAL HOSPITAL	SANTIAM MEMORIAL HOSPITAL - Cascade Medical Clinic	1369 N 10TH AVE	STAYTON	OR	Active
DSH380056G	Child	DSH	SANTIAM MEMORIAL HOSPITAL	SANTIAM MEMORIAL HOSPITAL - Santiam Medical Clinic	280 S 1ST AVE	MILL CITY	OR	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Pye, Tiffanie Ann Chief Operations Officer Santiam Memorial Hospital 5037692175	Pye, Tiffanie Ann Chief Operations Officer Santiam Memorial Hospital 5037692852	4/1/2025 11:39 AM
Details	Last Recertification Date	Update	Recertification	8/25/2023 3:05:35 PM	8/14/2024 11:54:41 AM	8/14/2024 11:54 AM
Contacts	Authorizing Official	Update	Profile Change Request	Hudson, Maggie Ann CFO/COO Santiam Memorial Hospital 5037699236	Hudson, Maggie Ann CEO Santiam Memorial Hospital 5037699236	11/9/2023 6:16 AM
Contacts	Signed By	Update	Profile Change Request	Hudson, Maggie Ann CFO/COO Santiam Memorial Hospital 5037699236	Hudson, Maggie Ann CEO Santiam Memorial Hospital 5037699236	11/9/2023 6:16 AM
Contacts	Primary Contact	Update	Profile Change Request	Pye, Tiffanie Ann Director of Pharmacy Santiam Memorial Hospital 5037692175	Pye, Tiffanie Ann Chief Operations Officer Santiam Memorial Hospital 5037692175	11/7/2023 12:24 PM
Details	Last Recertification Date	Update	Recertification	9/8/2022 7:45:40 PM	8/25/2023 3:05:35 PM	8/25/2023 3:05 PM
Addresses	Main Address	Update	Change Request	1375 N 10TH AVE STE B STAYTON, OR 97383-2099	1369 N 10TH AVE STAYTON, OR 97383	10/28/2022 3:36 PM
Details	Last Recertification Date	Update	Recertification	8/19/2021 8:16:57 PM	9/8/2022 7:45:40 PM	9/8/2022 7:45 PM
Details	Last Recertification Date	Update	Recertification		8/19/2021 8:16:57 PM	8/19/2021 8:16 PM
Details	State	Update		Approved	Active	7/1/2021 12:01 AM
Details	Comments Public	Insert	OPA Edit		Participating Start Date 7/1/2020, Termination 10/1/2020, Reinstatement 7/1/2021	4/19/2021 1:32 PM
Medicaid Billing	NPI: State	Update	Reinstatement		OR	4/19/2021 1:29 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	8/31/2020 12:00:00 AM		4/19/2021 1:29 PM
Dates	Participating Approval Date	Update	Reinstatement	4/17/2020 6:49:54 AM	4/19/2021 1:29:51 PM	4/19/2021 1:29 PM
Details	State	Update	Reinstatement	Terminated	Approved	4/19/2021 1:29 PM
Dates	Registration Date	Update	Reinstatement	4/10/2020 5:35:01 PM	4/14/2021 1:08:42 PM	4/19/2021 1:29 PM
Dates	Signed By Date	Update	Reinstatement	4/13/2020 5:52:35 PM	4/14/2021 1:08:46 PM	4/19/2021 1:29 PM
Dates	Start Date	Update	Reinstatement	7/1/2020 12:00:00 AM	7/1/2021 12:00:00 AM	4/19/2021 1:29 PM
Terminations	Termination Date	Update	Reinstatement	10/1/2020 12:00:00 AM		4/19/2021 1:29 PM
Terminations	Termination Effective Date	Update	Reinstatement	8/31/2020 12:00:00 AM		4/19/2021 1:29 PM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		4/19/2021 1:29 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		8/31/2020 12:00:00 AM	9/15/2020 8:45 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/15/2020 8:45 AM
Terminations	Termination Date	Update	Recertification		10/1/2020 12:00:00 AM	9/15/2020 8:45 AM
Terminations	Termination Effective Date	Update	Recertification		8/31/2020 12:00:00 AM	9/15/2020 8:45 AM
Terminations	Termination Reason	Update	Recertification		DSH percentage below statutory minimum	9/15/2020 8:45 AM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Contacts	Signed By	Insert	New Registration		Hudson, Maggie Ann CFO/COO Santiam Memorial Hospital 5037699236	4/17/2020 6:49 AM
Details	340B ID	Update	New Registration		DSH380056F	4/17/2020 6:49 AM
Details	Entity Subname	Update	New Registration	SANTIAM MEMORIAL HOSPITAL	SANTIAM MEMORIAL HOSPITAL - Cascade Medical Clinic	4/17/2020 6:49 AM
Dates	Participating Approval Date	Update	New Registration		4/17/2020 6:49:54 AM	4/17/2020 6:49 AM
Details	State	Update	New Registration	Pending	Approved	4/17/2020 6:49 AM
Dates	Signed By Date	Update	New Registration		4/13/2020 5:52:35 PM	4/17/2020 6:49 AM
Dates	Start Date	Update	New Registration		7/1/2020 12:00:00 AM	4/17/2020 6:49 AM
Addresses	Main Address	Insert	New Registration		1375 N 10TH AVE STE B STAYTON, OR 97383-2099	4/10/2020 5:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1790171874	4/10/2020 5:35 PM
Contacts	Primary Contact	Insert	New Registration		Pye, Tiffanie Ann Director of Pharmacy Santiam Memorial Hospital 5037692175	4/10/2020 5:35 PM
Contacts	Authorizing Official	Insert	New Registration		Hudson, Maggie Ann CFO/COO Santiam Memorial Hospital 5037699236	4/10/2020 5:35 PM
Details	Last Recertification Date	Insert	New Registration			4/10/2020 5:35 PM
Details	Grant Number	Insert	New Registration			4/10/2020 5:35 PM
Details	340B ID	Insert	New Registration			4/10/2020 5:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2020 5:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2020 5:35 PM
Details	Medicare Provider Number	Insert	New Registration		380056	4/10/2020 5:35 PM
Details	Entity Name	Insert	New Registration		SANTIAM MEMORIAL HOSPITAL	4/10/2020 5:35 PM
Details	Program Code	Insert	New Registration		DSH	4/10/2020 5:35 PM
Details	Entity Subname	Insert	New Registration		SANTIAM MEMORIAL HOSPITAL	4/10/2020 5:35 PM
Dates	Participating Approval Date	Insert	New Registration			4/10/2020 5:35 PM
Details	State	Insert	New Registration		Pending	4/10/2020 5:35 PM
Dates	Registration Date	Insert	New Registration		4/10/2020 5:35:01 PM	4/10/2020 5:35 PM
Dates	Signed By Date	Insert	New Registration			4/10/2020 5:35 PM
Dates	Start Date	Insert	New Registration			4/10/2020 5:35 PM
Terminations	Termination Comments	Insert	New Registration			4/10/2020 5:35 PM
Terminations	Termination Date	Insert	New Registration			4/10/2020 5:35 PM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2020 5:35 PM
Terminations	Termination Reason	Insert	New Registration			4/10/2020 5:35 PM