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DSH380022W SAMARITAN ALBANY GENERAL HOSPITAL (Terminated)
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Main Details
Name
SAMARITAN ALBANY GENERAL HOSPITAL
Subdivision Name
ALBANY GENERAL HOSPITAL / AGH Anticoag C 7th Ave
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380022W
Medicare Provider Number
380022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/28/2017
Last Recertification Date
9/3/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Samaritan Albany General Hospital
DANIEL B. 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
1086 7TH AVE SW
ALBANY, OR 97321-1997
Billing Address
SAMARITAN ALBANY GENERAL HOSPITAL
1046 6th Ave SW
Albany, OR 97321
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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