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SALEM HOSPITAL
CAH381308-00 Salem Health West Valley
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Covered Entity Details
Entity Name
Salem Health West Valley
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381308-00
Entity Address
525 SE WASHINGTON STREET
DALLAS, OR 97338-0378
Medicare Provider Number
381308
Participating Start Date
1/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
SALEM HOSPITAL
Pharmacy Address
SALEM HEALTH RETAIL PHARMACY
875 OAK ST SE
SALEM, OR 97301-3975
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Josh Free, Chief Pharmacy Officer
(503) 814-2773
Contract Pharmacy Representative
Salem Health Hospitals and Clinics
Josh Free, Chief Pharmacy Officer
(503) 814-2773
Signed By Date
10/15/2020
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