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SAMARITAN 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
SAMARITAN ALBANY GENERAL HOSPITAL
Pharmacy Address
ELM STREET PHARMACY
1010 7TH AVE SW
ALBANY, OR 97321
Pharmacy Comments
Contract Details
Approval Date
6/15/2012
Contract Begin Date
6/22/2012
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
6/8/2012
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