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SAMARITAN LEBANON COMMUNITY PHARMACY
CAH381323-00 MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381323-00
Entity Address
525 N. SANTIAM HWY
LEBANON, OR 97355
Medicare Provider Number
381323
Participating Start Date
8/4/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
SAMARITAN LEBANON COMMUNITY PHARMACY
Pharmacy Address
675 N 5TH ST
LEBANON, OR 97355-2875
Pharmacy Comments
Contract Details
Approval Date
11/9/2011
Contract Begin Date
11/9/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2015
Agreement registered in error
Contacts
Covered Entity Signing Official
Becky A. Pape, C.E.O.
(541) 451-7107
Contract Pharmacy Representative
Good Samaritan Regional Medical Center
Penny Reher, Chief Pharmacy Officer
(541) 768-6177
Signed By Date
10/25/2011
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