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CAH381314-13 SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL (Terminated)
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Main Details
Name
SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL
Subdivision Name
SAMARITAN CENTRAL COAST INTERNAL MEDICINE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381314-13
Medicare Provider Number
381314
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/15/2016
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
10/1/2019
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
930 SW Abbey Street Ste A
NEWPORT, OR 97365-4850
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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