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DSH380022Q SAMARITAN ALBANY GENERAL HOSPITAL (Terminated)
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Main Details
Name
SAMARITAN ALBANY GENERAL HOSPITAL
Subdivision Name
Wound Ostomy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380022Q
Medicare Provider Number
380022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/4/2015
Last Recertification Date
11/17/2017
Termination Date
Termination Reason
10/1/2018
Other
Contacts
Authorizing Official
Samaritan Albany General Hospital
DANIEL B. 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
400 NW Hickory Street
Suite 101
Albany, OR 97321
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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