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DSH380029K SILVERTON HEALTH DBA LEGACY SILVERTON MEDICAL CENTER OR SILVERTON HEALTH (Active)
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Main Details
Name
SILVERTON HEALTH DBA LEGACY SILVERTON MEDICAL CENTER OR SILVERTON HEALTH
Subdivision Name
Legacy Medical Group Family Medicine Mt Angel / LMG Mt Angel 505-8755
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380029K
Medicare Provider Number
380029
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/17/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/26/2020
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
250 W Marquam St
Mt Angel, OR 97362
Billing Address
SILVERTON HEALTH
342 FAIRVIEW STREET
SILVERTON, OR 97381
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2014, terminated 10/1/2016. Reinstated 4/1/2020.
02/26/2020
June 2025
June 2025
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