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CAH381323-01 MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL (Terminated)
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Main Details
Name
MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL
Subdivision Name
Samaritan Hemotology and Oncology Consultants
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381323-01
Medicare Provider Number
381323
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/3/2012
Participating Start Date
1/1/2013
Participating Approval Date
11/9/2012
Last Recertification Date
8/27/2014
Termination Date
Termination Reason
7/1/2015
Site closure
Contacts
Authorizing Official
Samaritan Health Services
Daniel Smith, VP Finance/CFO
(541) 768-5390
Primary Contact
Good Samaritan Regional Medical Center
Penny Reher, Chief Pharmacy Officer
(541) 768-6177
Addresses
Street Address
525 North Santiam Highway
Lebanon, OR 97355
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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