Covered Entity Details

CAH321301-08 SOCORRO GENERAL HOSPITAL (Active) - information as of 5/4/2025 10:24:04 PM

Main Details

Name

SOCORRO GENERAL HOSPITAL

Subdivision Name

Presbyterian Medical Group Cardiology at Socorro General Hospital - Cardiology

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH321301-08

Medicare Provider Number

321301

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/3/2018

Participating Start Date

10/1/2018

Participating Approval Date

7/11/2018

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

Presbyterian Healthcare Services
Erica Downing, VP, Pharmacy and Infusion Services & Chief Pharmacy Officer
(505) 724-8994

Primary Contact

Presbyterian Healthcare Services
Barbara Fried-Smith, 340B Program Coordinator
(505) 886-4820

Addresses

Street Address

1202 Highway 60 West
Building D
Socorro, NM 87801

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH321301-01	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group Family Medicine at Socorro General Hospital	1202 Highway 60 West	Socorro	NM	Active
CAH321301-02	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group Internal Medicine at Socorro General Hospital	1202 Highway 60 West	Socorro	NM	Terminated
CAH321301-03	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group Obstetrics and Gynecology at Socorro General Hospital	1202 Highway 60 West	Socorro	NM	Active
CAH321301-04	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group Podiatry at Socorro General Hospital	1202 Highway 60 West	Socorro	NM	Active
CAH321301-05	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group General Surgery at Socorro General Hospital	1202 Highway 60 West	Socorro	NM	Active
CAH321301-06	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group Pediatrics at Socorro General Hospital	1202 Highway 60 West	Socorro	NM	Terminated
CAH321301-07	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group Behavioral Health at Socorro General Hospital	1202 Highway 60 West	Socorro	NM	Active
CAH321301-08	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group Cardiology at Socorro General Hospital - Cardiology	1202 Highway 60 West	Socorro	NM	Active
CAH321301-09	Child	CAH	SOCORRO GENERAL HOSPITAL	Presbyterian Medical Group Urgent Care at Socorro General Hospital - Urgent Care	1202 Highway 60 West	Socorro	NM	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/29/2023 5:14:25 PM	9/4/2024 10:09:55 AM	9/4/2024 10:09 AM
Contacts	Primary Contact	Update	Group Change Request	Shreve, Patrick 340B Analyst III Presbyterian Healthcare Services 5057247192	Fried-Smith, Barbara 340B Program Coordinator Presbyterian Healthcare Services 5058864820	7/31/2024 7:14 AM
Contacts	Primary Contact	Update	Group Change Request	Green, Kelly 340B Program Manager Presbyterian Healthcare Services 5057247761	Shreve, Patrick 340B Analyst III Presbyterian Healthcare Services 5057247192	3/18/2024 8:24 AM
Details	Last Recertification Date	Update	Recertification	9/16/2022 1:58:55 PM	8/29/2023 5:14:25 PM	8/29/2023 5:14 PM
Details	Last Recertification Date	Update	Recertification	9/13/2021 10:17:27 AM	9/16/2022 1:58:55 PM	9/16/2022 1:58 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	00695 (NM)		7/14/2022 11:39 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1104802354 (NM)		7/14/2022 11:39 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1790761138 (NM)		7/14/2022 11:39 AM
Contacts	Authorizing Official	Update	Change Request	Graham, David Scott VP-PDS Clinical Support Srvc Presbyterian Healthcare Services 5058411872	Downing, Erica VP, Pharmacy and Infusion Services & Chief Pharmacy Officer Presbyterian Healthcare Services 5057248994	3/5/2022 8:43 AM
Details	Last Recertification Date	Update	Recertification	9/14/2020 3:56:17 PM	9/13/2021 10:17:27 AM	9/13/2021 10:17 AM
Addresses	Main Address	Update	Recertification	1202 Highway 60 West Socorro, NM 87801	1202 Highway 60 West Building D Socorro, NM 87801	9/14/2020 3:56 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1104802354	9/14/2020 3:56 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/14/2020 3:56 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1790761138	9/14/2020 3:56 PM
Medicaid Billing	NPI: State	Insert	Recertification		NM	9/14/2020 3:56 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1790761138 ( )		9/14/2020 3:56 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104802354 ( )		9/14/2020 3:56 PM
Details	Last Recertification Date	Update	Recertification	8/21/2019 11:51:46 AM	9/14/2020 3:56:17 PM	9/14/2020 3:56 PM
Contacts	Authorizing Official	Update	Change Request	Larsen, Roger Sr. Vice President and Chief Financial Officer Presbyterian Healthcare Services 5059235338	Graham, David Scott VP-PDS Clinical Support Srvc Presbyterian Healthcare Services 5058411872	2/18/2020 6:12 AM
Details	Last Recertification Date	Update	Recertification		8/21/2019 11:51:46 AM	8/21/2019 11:51 AM
Contacts	Primary Contact	Update	Change Request	Knight, Lauris 340B Program Coordinator Presbyterian Healthcare Services 5057248028	Green, Kelly 340B Program Manager Presbyterian Healthcare Services 5057247761	4/1/2019 8:45 AM
Contacts	Authorizing Official	Update	Change Request	Podley, Sandra C. VP Operations PDS Presbyterian Healthcare Services 5059235364	Larsen, Roger Sr. Vice President and Chief Financial Officer Presbyterian Healthcare Services 5059235338	4/1/2019 8:42 AM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Podley, Sandra C. VP Operations PDS Presbyterian Healthcare Services 5059235364	7/11/2018 7:32 AM
Details	340B ID	Update	New Registration		CAH321301-08	7/11/2018 7:32 AM
Details	Entity Subname	Update	New Registration	Presbyterian Medical Group Cardiology at Socorro General Hospital	Presbyterian Medical Group Cardiology at Socorro General Hospital - Cardiology	7/11/2018 7:32 AM
Dates	Participating Approval Date	Update	New Registration		7/11/2018 7:32:03 AM	7/11/2018 7:32 AM
Details	State	Update	New Registration	Pending	Approved	7/11/2018 7:32 AM
Dates	Signed By Date	Update	New Registration		7/9/2018 1:23:29 PM	7/11/2018 7:32 AM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	7/11/2018 7:32 AM
Addresses	Main Address	Insert	New Registration		1202 Highway 60 West Socorro, NM 87801	7/3/2018 2:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/3/2018 2:50 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		00695	7/3/2018 2:50 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NM	7/3/2018 2:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1790761138	7/3/2018 2:50 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104802354	7/3/2018 2:50 PM
Contacts	Primary Contact	Insert	New Registration		Knight, Lauris 340B Program Coordinator Presbyterian Healthcare Services 5057248028	7/3/2018 2:50 PM
Contacts	Authorizing Official	Insert	New Registration		Podley, Sandra C. VP Operations PDS Presbyterian Healthcare Services 5059235364	7/3/2018 2:50 PM
Details	Last Recertification Date	Insert	New Registration			7/3/2018 2:50 PM
Details	Grant Number	Insert	New Registration			7/3/2018 2:50 PM
Details	340B ID	Insert	New Registration			7/3/2018 2:50 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/3/2018 2:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/3/2018 2:50 PM
Details	Medicare Provider Number	Insert	New Registration		321301	7/3/2018 2:50 PM
Details	Entity Name	Insert	New Registration		SOCORRO GENERAL HOSPITAL	7/3/2018 2:50 PM
Details	Program Code	Insert	New Registration		CAH	7/3/2018 2:50 PM
Details	Entity Subname	Insert	New Registration		Presbyterian Medical Group Cardiology at Socorro General Hospital	7/3/2018 2:50 PM
Dates	Participating Approval Date	Insert	New Registration			7/3/2018 2:50 PM
Details	State	Insert	New Registration		Pending	7/3/2018 2:50 PM
Dates	Registration Date	Insert	New Registration		7/3/2018 2:50:43 PM	7/3/2018 2:50 PM
Dates	Signed By Date	Insert	New Registration			7/3/2018 2:50 PM
Dates	Start Date	Insert	New Registration			7/3/2018 2:50 PM
Terminations	Termination Comments	Insert	New Registration			7/3/2018 2:50 PM
Terminations	Termination Date	Insert	New Registration			7/3/2018 2:50 PM
Terminations	Termination Effective Date	Insert	New Registration			7/3/2018 2:50 PM
Terminations	Termination Reason	Insert	New Registration			7/3/2018 2:50 PM