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DSH500150H LEGACY SALMON CREEK HOSPITAL (Active)
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Main Details
Name
LEGACY SALMON CREEK HOSPITAL
Subdivision Name
Legacy Medical Group Family Medicine / LMG Salmon Creek Family Med 625-3963
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500150H
Medicare Provider Number
500150
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
8/30/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/19/2012
Last Recertification Date
9/2/2024
Contacts
Authorizing Official
Legacy Health
Kecia Kelly, SVP Chief Nursing Officer
(503) 415-5199
Primary Contact
Legacy Health
Elena Valcarlos, Pharmacy Systems Manager
(503) 413-7764
Addresses
Street Address
2101 NE 139th St
450
Vancouver, WA 98686
Billing Address
LEGACY SALMON CREEK MEDICAL CENTER
2211 NE 139TH ST
VANCOUVER, WA 98686
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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