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SAMARITAN PHARMACY - SWEET HOME
RRC380014-00 GOOD SAMARITAN HOSPITAL CORVALLIS
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Covered Entity Details
Entity Name
GOOD SAMARITAN HOSPITAL CORVALLIS
Subdivision Name
Type
Rural Referral Center
340B ID
RRC380014-00
Entity Address
3600 NW SAMARITAN DRIVE
CORVALLIS, OR 97330
Medicare Provider Number
380014
Participating Start Date
10/1/2018
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
SAMARITAN PHARMACY - SWEET HOME
Pharmacy Address
1289 49TH AVE STE 104
SWEET HOME, OR 97386
Pharmacy Comments
Contract Details
Approval Date
1/10/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Smith, VP Finance/CFO
(541) 768-5390
Contract Pharmacy Representative
Samaritan Lebanon Community Hospital
Daniel Rackham, Chief Executive Officer
(541) 451-7914
Signed By Date
1/10/2024
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