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DSH380007T LEGACY EMANUEL HOSPITAL & HEALTH CENTER (Terminated)
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Main Details
Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Legacy Emanuel Trauma NeuroTrauma Clinic - Trauma Clinic 150-2269
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380007T
Medicare Provider Number
380007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/8/2019
Last Recertification Date
9/8/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Legacy Health
Majid Tanas, VP Pharmacy Services
(503) 415-5011
Primary Contact
Legacy Health
Elena Valcarlos, Pharmacy Systems Manager
(503) 413-7764
Addresses
Street Address
300 N Graham St
125
Portland, OR 97227
Billing Address
LEGACY EMANUEL HOSPITAL & HEALTH CTR
2801 N Gantenbein
Portland, OR 97227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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