Covered Entity Details

CAH381314-17 SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL (Active) - information as of 5/29/2025 2:02:04 AM

Main Details

Name

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

Subdivision Name

PCH Walk In Clinic - PCH Walk In Clinic

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH381314-17

Medicare Provider Number

381314

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/10/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/11/2022

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

705 SW Coast Hwy
Neport, OR 97365

Billing Address

Samaritan Health Services
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	268916,500652572	1801847066

Shipping Addresses

Shipping Address 1

Samaritan Pacific Health Services, Inc. DBA Samaritan Pacific Communities Hospital
930 SW Abby Street
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 6:00:35 PM	8/23/2024 3:47:55 PM	8/23/2024 3:47 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 3:09:11 PM	8/28/2023 6:00:35 PM	8/28/2023 6:00 PM
Details	Last Recertification Date	Update	Recertification		8/30/2022 3:09:11 PM	8/30/2022 3:09 PM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
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 7:13 AM
Contacts	Signed By	Insert	New Registration		Smith, Daniel VP Finance/CFO Samaritan Health Services 5417685390	1/11/2022 8:40 AM
Details	340B ID	Update	New Registration		CAH381314-17	1/11/2022 8:40 AM
Details	Entity Name	Update	New Registration	SAMARITAN PACIFIC COMM HOSPIAL	SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL	1/11/2022 8:40 AM
Details	Entity Subname	Update	New Registration	PCH Walk In Clinic	PCH Walk In Clinic - PCH Walk In Clinic	1/11/2022 8:40 AM
Dates	Participating Approval Date	Update	New Registration		1/11/2022 8:40:39 AM	1/11/2022 8:40 AM
Details	State	Update	New Registration	Pending	Approved	1/11/2022 8:40 AM
Dates	Signed By Date	Update	New Registration		1/10/2022 5:22:05 PM	1/11/2022 8:40 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/11/2022 8:40 AM
Addresses	Main Address	Insert	New Registration		705 SW Coast Hwy Neport, OR 97365	1/10/2022 3:17 PM
Addresses	Billing Address	Insert	New Registration		Samaritan Health Services PO Box 3000 Corvallis, OR 97339	1/10/2022 3:17 PM
Addresses	Shipping Address	Insert	New Registration		Samaritan Pacific Health Services, Inc. DBA Samaritan Pacific Communities Hospital 930 SW Abby Street Newport, OR 97365	1/10/2022 3:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/10/2022 3:17 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		268916	1/10/2022 3:17 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	1/10/2022 3:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/10/2022 3:17 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		500652572	1/10/2022 3:17 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		OR	1/10/2022 3:17 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1801847066	1/10/2022 3:17 PM
Medicaid Billing	NPI: State	Insert	New Registration		OR	1/10/2022 3:17 PM
Contacts	Primary Contact	Insert	New Registration		Douglas, Joy R Rx data Coordinator - 340B Contract Pharmacy Samaritan Health Services 5417686867	1/10/2022 3:17 PM
Contacts	Authorizing Official	Insert	New Registration		Smith, Daniel VP Finance/CFO Samaritan Health Services 5417685390	1/10/2022 3:17 PM
Details	Assistance Received From Date	Insert	New Registration			1/10/2022 3:17 PM
Details	Assistance Received To Date	Insert	New Registration			1/10/2022 3:17 PM
Details	Last Recertification Date	Insert	New Registration			1/10/2022 3:17 PM
Details	Grant Number	Insert	New Registration			1/10/2022 3:17 PM
Details	340B ID	Insert	New Registration			1/10/2022 3:17 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2022 3:17 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2022 3:17 PM
Details	Medicare Provider Number	Insert	New Registration		381314	1/10/2022 3:17 PM
Details	Entity Name	Insert	New Registration		SAMARITAN PACIFIC COMM HOSPIAL	1/10/2022 3:17 PM
Details	NOFO Number	Insert	New Registration			1/10/2022 3:17 PM
Details	Program Code	Insert	New Registration		CAH	1/10/2022 3:17 PM
Details	Entity Subname	Insert	New Registration		PCH Walk In Clinic	1/10/2022 3:17 PM
Dates	Participating Approval Date	Insert	New Registration			1/10/2022 3:17 PM
Details	State	Insert	New Registration		Pending	1/10/2022 3:17 PM
Dates	Registration Date	Insert	New Registration		1/10/2022 3:17:53 PM	1/10/2022 3:17 PM
Dates	Signed By Date	Insert	New Registration			1/10/2022 3:17 PM
Dates	Start Date	Insert	New Registration			1/10/2022 3:17 PM
Terminations	Termination Comments	Insert	New Registration			1/10/2022 3:17 PM
Terminations	Termination Date	Insert	New Registration			1/10/2022 3:17 PM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2022 3:17 PM
Terminations	Termination Reason	Insert	New Registration			1/10/2022 3:17 PM