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DSH380060D Adventist Medical Center-Portland (Terminated)
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Main Details
Name
Adventist Medical Center-Portland
Subdivision Name
Home Infusion Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380060D
Medicare Provider Number
380060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/1/2011
Participating Start Date
1/1/2012
Participating Approval Date
12/15/2011
Last Recertification Date
8/23/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Adventist Health Portland
Donald E. Welch, CFO
(503) 261-4406
Primary Contact
Janice Hogue, Director, Pharmacy Services
(503) 251-6142
Addresses
Street Address
5835 NE 122nd Ave, #155
Portland, OR 97230
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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