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DSH380007Q LEGACY EMANUEL HOSPITAL & HEALTH CENTER (Active)
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Main Details
Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Legacy Emanuel Devers Eye Institute / Devers Eye Clinic 150-3903
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380007Q
Medicare Provider Number
380007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/7/2018
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
300 N Graham St
300
Portland, OR 97227
Billing Address
Legacy Emanuel Medical Center
2801 N Gantenbein Ave
Portland, OR 97227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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