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DSH380056B SANTIAM MEMORIAL HOSPITAL (Active)
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Main Details
Name
SANTIAM MEMORIAL HOSPITAL
Subdivision Name
SANTIAM MEMORIAL HOSPITAL - Santiam Hospital Outpatient Treatment Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380056B
Medicare Provider Number
380056
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/20/2023
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Santiam Memorial Hospital
Maggie Ann Hudson, CEO
(503) 769-9236
Primary Contact
Santiam Memorial Hospital
Tiffanie Ann Pye, Chief Operations Officer
(503) 769-2852
Addresses
Street Address
1401 N 10TH AVE
STAYTON, OR 97383-1311
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 7/1/2020, Termination Date 10/1/2020, Reinstatement 1/1/2024
10/19/2023
June 2025
June 2025
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