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CAH381323-15 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
MID-VALLEY HEALTHCARE, INC. / LCH Anticoag A Park Street
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH381323-15
Medicare Provider Number
381323
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/26/2017
Last Recertification Date
8/28/2018
Termination Date
Termination Reason
7/1/2019
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
325 PARK ST
LEBANON, OR 97355-4229
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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