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DSH380075 PROVIDENCE MEDFORD MEDICAL CENTER (Active)
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Main Details
Name
PROVIDENCE MEDFORD MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380075
Medicare Provider Number
380075
Additional Details
Current Program Status
Active
Registration Date
4/8/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
Providence Medford Medical Center
susan sauder, cfo
(971) 358-3119
Primary Contact
Providence Health and Services
Mac Ovenell, 340B Director
(509) 860-8643
Addresses
Street Address
1111 CRATER LAKE AVENUE
MEDFORD, OR 97504
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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