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DSH380007K LEGACY EMANUEL MEDICAL CENTER (Terminated)
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Main Details
Name
LEGACY EMANUEL MEDICAL CENTER
Subdivision Name
LEMC Podiatry
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380007K
Medicare Provider Number
380007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/26/2016
Last Recertification Date
Termination Date
Termination Reason
7/1/2017
Site closure
Contacts
Authorizing Official
Legacy Health
Anna Loomis, SVP Chief Financial Officer
(503) 415-5730
Primary Contact
Legacy Health
Kathleen C. Stoner, Vice President Supply Chain and Pharmacy Services
(503) 944-4276
Addresses
Street Address
2800 N Vancouver Ste 130
Portland, OR 97227-1668
Billing Address
Legacy Emanuel Medical Center
2801 N Gantenbein Ave.
Portland, OR 97227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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