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APOTHECARY AT SALMON CREEK
DSH380029 SILVERTON HEALTH DBA LEGACY SILVERTON MEDICAL CENTER OR SILVERTON HEALTH
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Covered Entity Details
Entity Name
SILVERTON HEALTH DBA LEGACY SILVERTON MEDICAL CENTER OR SILVERTON HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380029
Entity Address
342 FAIRVIEW STREET
SILVERTON, OR 97381-1993
Medicare Provider Number
380029
Participating Start Date
1/1/2019
Last Recertification Date
9/2/2024
Pharmacy Details
Pharmacy Name
APOTHECARY AT SALMON CREEK
Pharmacy Address
2121 NE 139TH ST STE 310
VANCOUVER, WA 98686
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carol Bradley, SVP and Chief Nursing Officer
(503) 415-5199
Contract Pharmacy Representative
Legacy Health
Kathleen C. Stoner, Vice President Supply Chain and Pharmacy Services
(503) 944-4276
Signed By Date
1/14/2019
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