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DSH380014 GOOD SAMARITAN HOSPITAL CORVALLIS (Terminated)
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Main Details
Name
GOOD SAMARITAN HOSPITAL CORVALLIS
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380014
Medicare Provider Number
380014
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/17/2017
Last Recertification Date
11/18/2017
Termination Date
Termination Reason
7/1/2018
DSH percentage below statutory minimum
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
3600 NW SAMARITAN DRIVE
CORVALLIS, OR 97330
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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