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CAH381323-14 MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL (Terminated)
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Main Details
Name
MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL
Subdivision Name
LCH WOUND CARE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381323-14
Medicare Provider Number
381323
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2017
Participating Start Date
4/1/2017
Participating Approval Date
1/17/2017
Last Recertification Date
Termination Date
Termination Reason
1/1/2018
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Samaritan Health Services
Daniel Smith, VP Finance/CFO
(541) 768-5390
Primary Contact
Frieda Drummond, 340B Split Billing Coordinator
(541) 768-5200
Addresses
Street Address
679 Main Street
Suite B
Sweet Home, OR 97386
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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