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DSH500150T LEGACY SALMON CREEK HOSPITAL (Active)
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Main Details
Name
LEGACY SALMON CREEK HOSPITAL
Subdivision Name
Legacy Salmon Creek DTU at the Vancouver Clinic / TVC Infusion Clinic 600-3550
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500150T
Medicare Provider Number
500150
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/21/2017
Last Recertification Date
9/2/2024
Contacts
Authorizing Official
Legacy Health
Kecia Kelly, SVP Chief Nursing Officer
(503) 415-5199
Primary Contact
Legacy Health
Elena Valcarlos, Pharmacy Systems Manager
(503) 413-7764
Addresses
Street Address
700 NE 87th Ave
360
Vancouver, WA 98664
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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