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DSH380060V Portland Adventist Medical Center dba Adventist Health Portland (Terminated)
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Main Details
Name
Portland Adventist Medical Center dba Adventist Health Portland
Subdivision Name
Hyperbaric Oxygen Therapy and Wound care - Hyperbaric Oxygen Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH380060V
Medicare Provider Number
380060
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/6/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/1/2023
Last Recertification Date
Termination Date
Termination Reason
1/1/2024
Other
Contacts
Authorizing Official
Portland Adventist Medical Center dba Adventist Health Portland
Jason Panasuk, Finance Officer
(503) 251-6121
Primary Contact
Adventist Health Portland
Kirsten Wallskog Sedgwick, Director of Pharmacy
(503) 251-6141
Addresses
Street Address
10201 SE Main St
9
Portland, OR 97216
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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