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DSH500150G LEGACY SALMON CREEK HOSPITAL (Terminated)
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Main Details
Name
LEGACY SALMON CREEK HOSPITAL
Subdivision Name
Legacy Medical Group Battle Ground
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500150G
Medicare Provider Number
500150
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/30/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/19/2012
Last Recertification Date
11/17/2017
Termination Date
Termination Reason
7/1/2018
Site closure
Contacts
Authorizing Official
Legacy Health
Anna Loomis, SVP Chief Financial Officer
(503) 415-5730
Primary Contact
Legacy Health
Kathleen C. Stoner, Vice President Supply Chain and Pharmacy Services
(503) 944-4276
Addresses
Street Address
1910 SW 9th Avenue, Suite 100
The Gardner Center
Battle Ground, WA 98604
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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