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ALBANY GENERAL HOSPITAL
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
ALBANY GENERAL HOSPITAL
Pharmacy Address
GEARY STREET CLINIC PHARMACY
1700 GEARY STREET SE
ALBANY, OR 97322
Pharmacy Comments
updated zip (was 97321)
Contract Details
Approval Date
4/20/2012
Contract Begin Date
4/20/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Smith, VP Finance/CFO
(541) 768-5390
Contract Pharmacy Representative
Samaritan Health Services
Cody Aichele, Outpatient Pharmacy Supervisor
(541) 768-6095
Signed By Date
4/27/2012
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