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GOOD SAMARITAN HOSP CORVALLIS
CAH381314-00 SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN PACIFIC HEALTH SERVICES, INC., DBA SAMARITAN PACIFIC COMMUNITIES HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381314-00
Entity Address
930 SW Abbey Street
NEWPORT, OR 97365
Medicare Provider Number
381314
Participating Start Date
8/3/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
GOOD SAMARITAN HOSP CORVALLIS
Pharmacy Address
DBA: SAMARITAN PHARMACY SERVICES
3521 NW SAMARITAN DR
STE 202
CORVALLIS, OR 97330
Pharmacy Comments
Contract Details
Approval Date
4/2/2013
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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