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DSH500150U LEGACY SALMON CREEK HOSPITAL (Terminated)
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Main Details
Name
LEGACY SALMON CREEK HOSPITAL
Subdivision Name
LEGACY MEDICAL GROUP GYNECOLOGIC ONCOLOGY-SALMON CREEK MEDICAL CENTER - GYNECOLOGIC ONCOLOGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500150U
Medicare Provider Number
500150
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/21/2017
Last Recertification Date
9/9/2019
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
Legacy Health
Anna Loomis, SVP Chief Financial Officer
(503) 415-5730
Primary Contact
Legacy Health
Elena Valcarlos, Pharmacy Systems Manager
(503) 413-7764
Addresses
Street Address
2121 NE 139th St
MOB A, Suite 120
Vancouver, WA 98686
Billing Address
LEGACY SALMON CREEK HOSPITAL
2211 NE 139TH St
Vancouver, WA 98686
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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