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CAH381314-12 SAMARITAN PACIFIC COMM HOSPIAL (Terminated)
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Main Details
Name
SAMARITAN PACIFIC COMM HOSPIAL
Subdivision Name
SAMARITAN INFECTION DISEASE-DEPOE B
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381314-12
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
Termination Date
Termination Reason
1/1/2017
Site closure
Contacts
Authorizing Official
Samaritan Health Services
Daniel Smith, VP Finance/CFO
(541) 768-5390
Primary Contact
Samaritan Health Services
Daniel Smith, VP Finance/CFO
(541) 768-5390
Addresses
Street Address
531 NW HWY 101
SUITE A
DEPOE BAY, OR 97341-9801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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