340B Drug Pricing Program Database
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DSH380007W LEGACY EMANUEL HOSPITAL & HEALTH CENTER (Terminated)
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Main Details
Name
LEGACY EMANUEL HOSPITAL & HEALTH CENTER
Subdivision Name
Legacy Emanuel Radiation Oncology / Radiology Diagnostic 150-3512
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380007W
Medicare Provider Number
380007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/29/2020
Last Recertification Date
9/13/2021
Termination Date
Termination Reason
10/1/2022
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
450 N Graham St
Portland, OR 97227-1682
Billing Address
Legacy Emanuel Hospital & Health Center
2801 N Gantenbein Ave
Portland, OR 97227
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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