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DSH380007N LEGACY EMANUEL HOSPITAL & HEALTH CENTER (Terminated)
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Main Details
Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Unity Center for Behavioral Health Emergency Department - A Service of Legacy Emanuel - Unity Center for Behavioral Health Emergency Department
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380007N
Medicare Provider Number
380007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/18/2017
Last Recertification Date
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
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
1225 NE 2ND AVE
PORTLAND, OR 97232-2003
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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