340B Drug Pricing Program Database


DSH320001DD UNIVERSITY OF NEW MEXICO HOSPITAL (Active) - information as of 6/24/2025 12:04:19 AM

Main Details
UNIVERSITY OF NEW MEXICO HOSPITAL
UNM Health Outpatient Clinical Services - Anticoagulation Services
Disproportionate Share Hospital
No
DSH320001DD
320001


Additional Details
Active
7/23/2020
10/1/2020
7/28/2020
9/4/2024

Contacts

UNM Hospitals
Bonnie White, Chief Financial Officer
(505) 272-1840

University of New Mexico Hospital
Lorena Vigil, Ambulatory Business Operations Mgr - 340B Program
(505) 272-2134

Addresses

1209 University Blvd NE
Albuquerque, NM 87102

UNM Hospital
PO Box 80600
Albuquerque, NM 87198


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NM000671689747552,1447464664,1699804807,1134165681,1982849030,1215233820,1629107834,1497170252,1255714101,1346623295,1891208633
AK10061141689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
AZ215691689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
CO90001521061689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
CT008059608,0080427611689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
FL973165001689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
GA000358025X1689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
IN3000027941689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
LA17417281689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
MD2610051001689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
NE100267225001689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
NJ2939541689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
OH5699791689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
OK100704770A1689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
PA88830800011689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
TN3200011689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
TX1078743031689747552,1134165681,1215233820,1255714101,1346623295,1447464664,1497170252,1629107834,1699804807,1891208633,1982849030
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH320001AChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNMH Family Health1209 University Blvd., NEALBUQUERQUENMActive
DSH320001AAChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL PSYCHIATRIC CENTER UPC Development Disability2600 MARBLE NEALBUQUERQUENMTerminated
DSH320001ABChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL CARRIE TINGLEY CLINIC1127 UNIVERSITY BLVD NEALBUQUERQUENMActive
DSH320001ACChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL FAMILY PRACTICE CLINIC2400 TUCKERALBUQUERQUENMActive
DSH320001ADChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL LOBO CARE/SENIOR HEALTH CLINIC1101-4 MEDICAL ARTS NE, Suite AALBUQUERQUENMActive
DSH320001AFChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNMH SOUTHWEST MESA CENTER FOR FAMILY AND COMMUNITY HEALTH301 UNSER BLVD NWALBUQUERQUENMActive
DSH320001AGChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNMH OSIS Sports Medicine Clinic1213 University Blvd. NEAlbuquerqueNMActive
DSH320001AHChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNMH Digestive Disease Endoscopy Center1001 Martin Luther King Jr. Drive NEAlbuquerqueNMActive
DSH320001AJChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNMH Center for Digestive Disease1001 Martin Luther King Jr. Drive NEAlbuquerqueNMActive
DSH320001AKChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNMH Pulmonary Hypertension1101 Medical Arts NE, Bldg 4, Suite BAlbuquerqueNMActive
DSH320001AMChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNMH Clinical Neurosciences Center900 Camino De Salud NEAlbuquerqueNMActive
DSH320001ANChildDSHUNIVERSITY OF NEW MEXICO HOSPITALAtrisco Heritage Clinic10800 Dennis Chavez Blvd SWAlbuquerqueNMActive
DSH320001APChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCoumadin Anticoagulation Clinic4808 McMahon Blvd NWAlbuquerqueNMTerminated
DSH320001ARChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCPC Programs for Children1031 Lamberton Pl. NEAlbuquerqueNMActive
DSH320001ASChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCimarron Clinic1031 Lamberton Pl. NEAlbuquerqueNMActive
DSH320001ATChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiation Oncology Clinic1201 Camino de Salud NE, Ground FloorAlbuquerqueNMActive
DSH320001AUChildDSHUNIVERSITY OF NEW MEXICO HOSPITALMedical Oncology Clinic1201 Camino de Salud NE, Third FloorAlbuquerqueNMActive
DSH320001AVChildDSHUNIVERSITY OF NEW MEXICO HOSPITALSurgical Oncology Clinic1201 Camino de Salud NEAlbuquerqueNMActive
DSH320001AWChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNIVERSITY OF NEW MEXICO / General Specialty Clinics2600 MARBLE AVE NEALBUQUERQUENMActive
DSH320001AXChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL / NEH ENT Allergy Clinic7801 ACADEMY RD NEALBUQUERQUENMActive
DSH320001AYChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL / Radiology Bone Densitometry1101 MEDICAL ARTS AVENUE NE, BLDG. 5ALBUQUERQUENMToBeTerminated
DSH320001AZChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL / CTH Transitions Clinic1127 UNIVERSITY BLVD., N.E.ALBUQUERQUENMTerminated
DSH320001BChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL OSIS Operating Room1213 UNIVERSITY BLVD.ALBUQUERQUENMActive
DSH320001BAChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL / Westside Allergy Clinic4808 MCMAHON BLVD NWALBUQUERQUENMActive
DSH320001BBChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUPC Continuing Care Clinic / Continuity Clinic2600 MARBLE AVE., NEALBUQUERQUENMTerminated
DSH320001BCChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL / Neurosurgery Clinic900 CAMINO DE SALUD, NEALBUQUERQUENMActive
DSH320001BDChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL / ASAP O/P Medical Services2600 MARBLE AVE NEALBUQUERQUENMTerminated
DSH320001BEChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL / Dermatology1201 Camino de SaludALBUQUERQUENMActive
DSH320001BFChildDSHUNIVERSITY OF NEW MEXICO HOSPITALPsychiatric Emergency Services2600 Marble NEALBUQUERQUENMActive
DSH320001BGChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNIVERSITY OF NEW MEXICO HOSPITAL B / COPE Clinic2600 MARBLE AVE., N.E.ALBUQUERQUENMActive
DSH320001BHChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCTH Pulmonary Services / Respiratory Therapy1127 University Blvd NEAlbuquerqueNMTerminated
DSH320001BJChildDSHUNIVERSITY OF NEW MEXICO HOSPITALGyn Oncology / Medical Oncology Clinic1201 Camino De Salud NEAlbuquerqueNMActive
DSH320001BKChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOrtho Oncology / Medical Oncology Clinic1201 Camino De SaludAlbuquerqueNMTerminated
DSH320001BLChildDSHUNIVERSITY OF NEW MEXICO HOSPITALMilagro OB Psychotherapy / Milagro OP Clinic3401 4th Street NWAlbuquerqueNMActive
DSH320001BMChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUPC Case Management / UPC Behavioral Health Clinic2600 Marble NEAlbuquerqueNMTerminated
DSH320001BNChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUPC Psychosocial Rehab PSI Prog / UPC Behavioral Health Clinic2001 B Centro Familiar SWAlbuquerqueNMTerminated
DSH320001BPChildDSHUNIVERSITY OF NEW MEXICO HOSPITALNeuropsychology / Neuroscience Clinic900 Camino De SaludAlbuquerqueNMTerminated
DSH320001BQChildDSHUNIVERSITY OF NEW MEXICO HOSPITALNeurodiagnostics Lab / Neuroscience Clinic900 Camino De Salud NEAlbuquerqueNMActive
DSH320001BRChildDSHUNIVERSITY OF NEW MEXICO HOSPITALMilagro OP Clinic / Psych Clinic8200 Central SEAlbuquerqueNMActive
DSH320001BSChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOPD Psych Providers, APNs / UPC Behavioral Health Clinic2600 Marble NE, First FloorAlbuquerqueNMTerminated
DSH320001BTChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUPC Psychotherapy Clinic / UPC Behavioral Health Clinic2600 Marble NE, Second FloorAlbuquerqueNMActive
DSH320001BUChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOSIS MRI / Magnetic Resonance Imaging1213 University Blvd NEAlbuquerqueNMActive
DSH320001BVChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOSIS CT Scan / CT Scan1213 University Blvd NEAlbuquerqueNMActive
DSH320001BWChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOSIS PET CT / CT Scan1213 University NEAlbuquerqueNMActive
DSH320001BXChildDSHUNIVERSITY OF NEW MEXICO HOSPITALDual Diagnosis Clinic / UPC Behavioral Health Clinic2600 Yale Blvd SEAlbuquerqueNMTerminated
DSH320001BYChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCarrie Tingley Clinic / CTH Speech and Language1127 University Blvd NEAlbuquerqueNMActive
DSH320001BZChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCarrie Tingley Clinic / CTH Radiology General1127 University Blvd NEAlbuquerqueNMActive
DSH320001CChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL ADULT INFUSION CENTER AT CRTC II1201 CAMINO DE SALUD NEALBUQUERQUENMActive
DSH320001CAChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCarrie Tingley Hospital / CTH Physical Therapy1127 University Blvd NEAlbuquerqueNMActive
DSH320001CBChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCarrie Tingley Clinic / CTH Radiology Bone Density1127 University Blvd NEAlbuquerqueNMActive
DSH320001CCChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCarrie Tingely Clinic / CTH Occupational Therapy1127 University Blvd NEAlbuquerqueNMActive
DSH320001CDChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCarrie Tingley Clinic / CTH Radiology Ultrasound1127 University Blvd NEAlbuquerqueNMActive
DSH320001CEChildDSHUNIVERSITY OF NEW MEXICO HOSPITALPain Clinic900 CAMINO DE SALUD NEAlbuquerqueNMActive
DSH320001CFChildDSHUNIVERSITY OF NEW MEXICO HOSPITALNorth Valley Clinic3401 North Fourth Street NWAlbuquerqueNMActive
DSH320001CGChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Diagnostic / Outpatient Surgical & Imaging Services- Mammography1213 University Blvd NEAlbuquerqueNMActive
DSH320001CHChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Diagnostics / Radiology - SW Mesa301 Unser Blvd NWAlbuquerqueNMActive
DSH320001CJChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Diagnostic / Radiology - SE Heights8200 Central Ave SEAlbuquerqueNMActive
DSH320001CKChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Diagnostic / Radiology - North Valley3401 North Fourth Street NWAlbuquerqueNMActive
DSH320001CLChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Diagnostic / Outpatient Surgical & Imaging Services- Ultrasound1213 University Blvd NEAlbuquerqueNMActive
DSH320001CMChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology Diagnostic / Radiology Ortho Clinic1101-5 MEDICAL ARTS, NEALBUQUERQUENMActive
DSH320001CNChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Diagnostic / Radiology 1209 University Blvd NEAlbuquerqueNMActive
DSH320001CPChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Diagnostic / Radiology - Family Practice2400 Tucker NEAlbuquerqueNMTerminated
DSH320001CQChildDSHUNIVERSITY OF NEW MEXICO HOSPITALMed Supplies Charged to Patients / Outpatient Surgicial & Imaging Sevices- Anesthesia1213 University Blvd NEAlbuquerqueNMActive
DSH320001CRChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRecovery Room / Outpatient Surgical & Imaging Services- Post Anesthesia Care Unit1213 University Blvd NEAlbuquerqueNMActive
DSH320001CSChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOperating Room / Outpatient Surgicial & Imaging Services-Satellite1213 University Blvd NEAlbuquerqueNMActive
DSH320001CTChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUPC Behavioral Health Clinic - ASAP Teen Addiction/Recovery2600 Yale SEAlbuquerqueNMToBeTerminated
DSH320001CUChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUPC Behavioral Health Clinic - UPC ICOPE Clinic-Primary Care2600 Marble NEAlbuquerqueNMActive
DSH320001CVChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUPC Behavioral Health Clinic - UPC Urgent Care Clinic2600 Marble NEAlbuquerqueNMActive
DSH320001CWChildDSHUNIVERSITY OF NEW MEXICO HOSPITALHospice - Hospice Care-Pediatric2600 Yale Blvd SEAlbuquerqueNMActive
DSH320001CXChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM Family Health Uptown - Women's Care Eubank2130 Eubank Blvd NEAlbuquerqueNMActive
DSH320001CYChildDSHUNIVERSITY OF NEW MEXICO HOSPITALWomens Health Clinic - Women's Imaging Eubank2130 Eubank Blvd NEAlbuquerqueNMActive
DSH320001CZChildDSHUNIVERSITY OF NEW MEXICO HOSPITALEubank Clinic - Pediatrics Eubank Clinic2130 Eubank Blvd NEAlbuquerqueNMActive
DSH320001DAChildDSHUNIVERSITY OF NEW MEXICO HOSPITALAdult Infusion Clinic - Stem Cell Transplant Program1201 CAMINO DE SALUD NEAlbuquerqueNMTerminated
DSH320001DBChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOperating Room1201 Camino de SaludAlbuquerqueNMActive
DSH320001DCChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Interventional Rad - Radiology1201 Camino De SaludAlbuquerqueNMActive
DSH320001DDChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM Health Outpatient Clinical Services - Anticoagulation Services1209 University Blvd NEAlbuquerqueNMActive
DSH320001DEChildDSHUNIVERSITY OF NEW MEXICO HOSPITALGallup Clinic - Gallup Multi-Disciplinary Clinic205 Nizhoni BlvdGallupNMActive
DSH320001DFChildDSHUNIVERSITY OF NEW MEXICO HOSPITALMovement Disorder Clinic - Movement Disorder Clinic909 Yale Blvd NEAlbuquerqueNMActive
DSH320001DGChildDSHUNIVERSITY OF NEW MEXICO HOSPITALAmbulatory COVID Screening Clinic - Ambulatory COVID Screening Clinic1131 University Blvd NEAlbuquerqueNMTerminated
DSH320001DHChildDSHUNIVERSITY OF NEW MEXICO HOSPITALEubank Clinic - Maternal Fetal Medicine2130 Eubank Blvd NEAlbuquerqueNMActive
DSH320001DJChildDSHUNIVERSITY OF NEW MEXICO HOSPITALNeuroscience Clinic - Neuropsychology Clinic900 Camino De Salud NEAlbuquerqueNMActive
DSH320001DKChildDSHUNIVERSITY OF NEW MEXICO HOSPITAL1209 Clinic - COVID Follow up Clinic1209 University Blvd NEAlbuquerqueNMActive
DSH320001DLChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNMH Senior Health Clinic - Senior Health Clinic1823 Camino de SaludAlbuquerqueNMActive
DSH320001DMChildDSHUNIVERSITY OF NEW MEXICO HOSPITALMHC Calm Clinic - Calm Clinic2600 Marble NeAlbuquerqueNMToBeTerminated
DSH320001DNChildDSHUNIVERSITY OF NEW MEXICO HOSPITALSurgical Specialty Clinics - SRMC Surgical Specialty Clinics3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DPChildDSHUNIVERSITY OF NEW MEXICO HOSPITALEndoscopy Center - SRMC Endoscopy Center3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DQChildDSHUNIVERSITY OF NEW MEXICO HOSPITALAudiology - SRMC Audiology3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DRChildDSHUNIVERSITY OF NEW MEXICO HOSPITALHeart Station - SRMC Heart Station3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DSChildDSHUNIVERSITY OF NEW MEXICO HOSPITALGeneral Surgery Clinic - SRMC General Surgery Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DTChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRheumatology Clinic - SRMC Rheumatology Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DUChildDSHUNIVERSITY OF NEW MEXICO HOSPITALLab - Blood Bank - SRMC Lab - Blood Bank3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DVChildDSHUNIVERSITY OF NEW MEXICO HOSPITALPACU - SRMC PACU3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DWChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - MRI - SRMC Radiology - MRI3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DXChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOPAT Clinic - SRMC OPAT Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DYChildDSHUNIVERSITY OF NEW MEXICO HOSPITALEndocrinology Clinic - SRMC Endocrinology Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001DZChildDSHUNIVERSITY OF NEW MEXICO HOSPITALMedical Specialty Clinics - SRMC Medical Specialty Clinics3001 Broadmoor Blvd NERio RanchoNMToBeTerminated
DSH320001EChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL YOUNG CHILDREN'S HEALTH CENTER306 SAN PABLO SEALBUQUERQUENMActive
DSH320001EAChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Ultrasound - SRMC Radiology - Ultrasound3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EBChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRehabilitation Services - SRMC Rehabilitation Services3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001ECChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - CT Scan - SRMC Radiology - CT Scan3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EDChildDSHUNIVERSITY OF NEW MEXICO HOSPITALPulmonary Hypertension Clinic - SRMC Pulmonary Hypertension Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EEChildDSHUNIVERSITY OF NEW MEXICO HOSPITALDermatology Clinic 1021 Med - SRMC Dermatology Clinic 1021 Med3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EFChildDSHUNIVERSITY OF NEW MEXICO HOSPITALDOIM-Outpatient Treatment Ctr - SRMC DOIM-Outpatient Treatment Ctr3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EGChildDSHUNIVERSITY OF NEW MEXICO HOSPITALLab - Tissue Bank - SRMC Lab - Tissue Bank3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EHChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - General - SRMC Radiology - General3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EJChildDSHUNIVERSITY OF NEW MEXICO HOSPITALAnesthesia - SRMC Anesthesia3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EKChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCardiac Cath Lab - SRMC Cardiac Cath Lab3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001ELChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Mammography - SRMC Radiology - Mammography3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EMChildDSHUNIVERSITY OF NEW MEXICO HOSPITALENT Surgical Specialty Clinic - SRMC ENT Surgical Specialty Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001ENChildDSHUNIVERSITY OF NEW MEXICO HOSPITALSurgical Clinic - Bariatric - SRMC Surgical Clinic - Bariatric3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EPChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Bone Densitrometry - SRMC Radiology - Bone Densitrometry3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EQChildDSHUNIVERSITY OF NEW MEXICO HOSPITALPulmonary Services - SRMC Pulmonary Services3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001ERChildDSHUNIVERSITY OF NEW MEXICO HOSPITALGastroenterology Clinic - SRMC Gastroenterology Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001ESChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCardiology Clinic - SRMC Cardiology Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001ETChildDSHUNIVERSITY OF NEW MEXICO HOSPITALWomen's Health Center - SRMC Women's Health Center3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EUChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOperating Room - SRMC Operating Room3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EVChildDSHUNIVERSITY OF NEW MEXICO HOSPITALRadiology - Nuclear Med - SRMC Radiology - Nuclear Med3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EWChildDSHUNIVERSITY OF NEW MEXICO HOSPITALFamily Practice Clinic - SRMC Family Practice Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EXChildDSHUNIVERSITY OF NEW MEXICO HOSPITALEmergency Department - SRMC Emergency Department3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EYChildDSHUNIVERSITY OF NEW MEXICO HOSPITALNephrology Clinic - SRMC Nephrology Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001EZChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOrthopaedics Clinic - SRMC Orthopaedics Clinic3200 Broadmoor Blvd NERio RanchoNMActive
DSH320001FChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL MATERNAL & FAMILY PLANNING CLINIC6900 GONZALES RD. SWALBUQUERQUENMActive
DSH320001FAChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOphthalmology Clinic - Eye Surgery Center - OR1600 University Blvd NEAlbuquerqueNMActive
DSH320001FBChildDSHUNIVERSITY OF NEW MEXICO HOSPITALOphthalmology Clinic - Eye Surgery Center - PACU1600 University Blvd NEAlbuquerqueNMActive
DSH320001FCChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL - Rehab Movement Disorders909 YALE BLVD NEALBUQUERQUENMActive
DSH320001FDChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL - Rehab Senior Center1823 CAMINO DE SALUD NEALBUQUERQUENMActive
DSH320001FEChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL - Neuropsychology900 CAMINO DE SALUD NEALBUQUERQUENMActive
DSH320001FFChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL - Crisis Triage Center2600 MARBLE AVE NEALBUQUERQUENMActive
DSH320001FGChildDSHUNIVERSITY OF NEW MEXICO HOSPITALSRMC Surgical Clinic-Urology - Surgical Specialties3200 Broadmoor Blvd NERio RanchoNMActive
DSH320001FHChildDSHUNIVERSITY OF NEW MEXICO HOSPITALSRMC Surgical Clinic-Uro/Gyn - SRMC-Medical Surgical Specialties Clinic3200 Broadmoor Blvd NERio RanchoNMActive
DSH320001FJChildDSHUNIVERSITY OF NEW MEXICO HOSPITALCPC Transition Age Clinic - CPC Child Psychiatric Clinic1001 Yale Blvd NEAlbuquerqueNMActive
DSH320001FKChildDSHUNIVERSITY OF NEW MEXICO HOSPITALM & I - Ttl X Fmly Pl - Maternal and Family Planning6900 Gonzalez Rd SW, Suite HAlbuquerqueNMActive
DSH320001FLChildDSHUNIVERSITY OF NEW MEXICO HOSPITALWomen's Health Care Physical Therapy - Physical Therapy2130 Eubank Blvd NEAlbuquerqueNMActive
DSH320001FMChildDSHUNIVERSITY OF NEW MEXICO HOSPITALSRMC BH Providers-Primary Clinic - SRMC-Family Practice Clinic3001 Broadmoor Blvd NERio RanchoNMActive
DSH320001FNChildDSHUNIVERSITY OF NEW MEXICO HOSPITALSRMC Plastic Surgery - SRMC Surgical Specialties clinic3200 Broadmoor Blvd NERio RanchoNMActive
DSH320001FPChildDSHUNIVERSITY OF NEW MEXICO HOSPITALASAP O/P - Counseling Svcs - Opioid Treatment Program (OTP)2600 Marble NEAlbuquerqueNMActive
DSH320001GChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL MATERNAL & FAMILY PLANNING CLINIC1500 WALTER ST. SEALBUQUERQUENMTerminated
DSH320001HChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL MATERNAL & FAMILY PLANNING CLINIC1231 CANDELARIA NWALBUQUERQUENMActive
DSH320001KChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL FAMILY HEALTH ACADEMY CLINIC7801 ACADEMY NEALBUQUERQUENMActive
DSH320001MChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL FAMILY HEALTH WESTSIDE CLINIC4808 MCMAHON BLVD NWALBUQUERQUENMActive
DSH320001NChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL SLEEP DISORDERS CENTER1101-2 MEDICAL ARTS, NEALBUQUERQUENMActive
DSH320001PChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL HEART & VASCULAR CENTER1101-4 MEDICAL ARTS NE, Building 4, Suite BALBUQUERQUENMActive
DSH320001QChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL ORTHOPEDICS FACULTY CLINIC1101-5 MEDICAL ARTS, NEALBUQUERQUENMActive
DSH320001RChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL CPC Community Family Team1001 YALE BLVD NEALBUQUERQUENMToBeTerminated
DSH320001SChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL SOUTH EAST HEIGHTS CENTER FOR FAMILY & COMMUNITY HEALTH8200 CENTRAL AVENUE SEALBUQUERQUENMActive
DSH320001TChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL DERMATOLOGY CLINIC1021 MEDICAL ARTS AVEALBUQUERQUENMActive
DSH320001UChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL PHYSICAL THERAPY REHAB SERVICES1025 MEDICAL ARTS AVEALBUQUERQUENMActive
DSH320001VChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL OPHTHALMOLOGY CLINIC1600 UNIVERSITY BLVD NEALBUQUERQUENMActive
DSH320001WChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL WOMEN'S FACULTY & MIDWIFE CLINIC2130 Eubank Blvd NEALBUQUERQUENMTerminated
DSH320001XChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY2701 FRONTIER NEALBUQUERQUENMTerminated
DSH320001YChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL ADDICTIONS & SUBSTANCE ABUSE PROGRAM2600 YALE SEALBUQUERQUENMActive
DSH320001ZChildDSHUNIVERSITY OF NEW MEXICO HOSPITALUNM HOSPITAL MILAGRO PROGRAM2400 Tucker NEALBUQUERQUENMActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdatePC Change RequestOrtega, Frieda Director of Pharmacy-Outpatient Pharmacy Services UNM Hospitals 5052720526Vigil, Lorena Ambulatory Business Operations Mgr - 340B Program University of New Mexico Hospital 50527221344/25/2025 1:37 PM
DetailsLast Recertification DateUpdateRecertification8/23/2023 6:34:12 PM9/4/2024 6:10:47 PM9/4/2024 6:10 PM
ContactsPrimary ContactUpdatePC Change RequestAchusim, Louis E Executive Director of Pharmacy UNM Hospital 5052722038Ortega, Frieda Director of Pharmacy-Outpatient Pharmacy Services UNM Hospitals 50527205265/31/2024 2:00 PM
DetailsLast Recertification DateUpdateRecertification9/14/2022 11:21:57 PM8/23/2023 6:34:12 PM8/23/2023 6:34 PM
DetailsLast Recertification DateUpdateRecertification9/9/2021 12:52:52 PM9/14/2022 11:21:57 PM9/14/2022 11:21 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request GA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CT7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NE7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OK7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TX7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request LA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request AZ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request MD7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request NJ7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request IN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request TN7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request OH7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request PA7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request CO7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656817/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338207/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141017/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232957/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646647/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702527/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078347/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048077/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086337/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490307/14/2022 5:45 PM
Medicaid BillingNPI: StateInsertChange Request FL7/14/2022 5:45 PM
DetailsLast Recertification DateUpdateRecertification 9/9/2021 12:52:52 PM9/9/2021 12:52 PM
Medicaid BillingNPI: NumberDeleteChange Request1689747552 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1447464664 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1699804807 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1134165681 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1982849030 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1215233820 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1629107834 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1497170252 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1255714101 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1346623295 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberDeleteChange Request1891208633 ( ) 4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 14474646644/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16998048074/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 11341656814/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 19828490304/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 12152338204/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16291078344/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 14971702524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 12557141014/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 13466232954/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 18912086334/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NM4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request GA4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request CT4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NE4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request AK4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request OK4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request TX4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request LA4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request AZ4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request MD4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request NJ4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request IN4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request TN4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request OH4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request PA4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request CO4/30/2021 12:25 PM
Medicaid BillingNPI: NumberInsertChange Request 16897475524/30/2021 12:25 PM
Medicaid BillingNPI: StateInsertChange Request FL4/30/2021 12:25 PM
DetailsStateUpdate ApprovedActive10/1/2020 12:01 AM
ContactsSigned ByInsertNew Registration White, Bonnie Chief Financial Officer UNM Hospitals 50527218407/28/2020 9:54 AM
Details340B IDUpdateNew Registration DSH320001DD7/28/2020 9:54 AM
DetailsEntity SubnameUpdateNew RegistrationUNM Health Outpatient Clinical ServicesUNM Health Outpatient Clinical Services - Anticoagulation Services7/28/2020 9:54 AM
DatesParticipating Approval DateUpdateNew Registration 7/28/2020 9:54:32 AM7/28/2020 9:54 AM
DetailsStateUpdateNew RegistrationPendingApproved7/28/2020 9:54 AM
DatesSigned By DateUpdateNew Registration 7/27/2020 11:13:27 AM7/28/2020 9:54 AM
DatesStart DateUpdateNew Registration 10/1/2020 12:00:00 AM7/28/2020 9:54 AM
AddressesMain AddressInsertNew Registration  1209 University Blvd NE Albuquerque, NM 871027/23/2020 5:01 PM
AddressesBilling AddressInsertNew Registration UNM Hospital PO Box 80600 Albuquerque, NM 871987/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 000677/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration NM7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 10061147/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration AK7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 215697/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration AZ7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 90001521067/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration CO7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 0080596087/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration CT7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 0080427617/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration CT7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 973165007/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration FL7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 000358025X7/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration GA7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 3000027947/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration IN7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 17417287/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration LA7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 2610051007/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration MD7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 100267225007/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration NE7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 2939547/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration NJ7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 5699797/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration OH7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 100704770A7/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration OK7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 88830800017/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration PA7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 3200017/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration TN7/23/2020 5:01 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/23/2020 5:01 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 1078743037/23/2020 5:01 PM
Medicaid BillingMedicaid: StateInsertNew Registration TX7/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 16897475527/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 14474646647/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 16998048077/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 11341656817/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 19828490307/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 12152338207/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 16291078347/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 14971702527/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 12557141017/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 13466232957/23/2020 5:01 PM
Medicaid BillingNPI: NumberInsertNew Registration 18912086337/23/2020 5:01 PM
ContactsPrimary ContactInsertNew Registration Achusim, Louis E Executive Director of Pharmacy UNM Hospital 50527220387/23/2020 5:01 PM
ContactsAuthorizing OfficialInsertNew Registration White, Bonnie Chief Financial Officer UNM Hospitals 50527218407/23/2020 5:01 PM
DetailsLast Recertification DateInsertNew Registration  7/23/2020 5:01 PM
DetailsGrant NumberInsertNew Registration  7/23/2020 5:01 PM
Details340B IDInsertNew Registration  7/23/2020 5:01 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/23/2020 5:01 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/23/2020 5:01 PM
DetailsMedicare Provider NumberInsertNew Registration 3200017/23/2020 5:01 PM
DetailsEntity NameInsertNew Registration UNIVERSITY OF NEW MEXICO HOSPITAL7/23/2020 5:01 PM
DetailsProgram CodeInsertNew Registration DSH7/23/2020 5:01 PM
DetailsEntity SubnameInsertNew Registration UNM Health Outpatient Clinical Services7/23/2020 5:01 PM
DatesParticipating Approval DateInsertNew Registration  7/23/2020 5:01 PM
DetailsStateInsertNew Registration Pending7/23/2020 5:01 PM
DatesRegistration DateInsertNew Registration 7/23/2020 5:01:47 PM7/23/2020 5:01 PM
DatesSigned By DateInsertNew Registration  7/23/2020 5:01 PM
DatesStart DateInsertNew Registration  7/23/2020 5:01 PM
TerminationsTermination CommentsInsertNew Registration  7/23/2020 5:01 PM
TerminationsTermination DateInsertNew Registration  7/23/2020 5:01 PM
TerminationsTermination Effective DateInsertNew Registration  7/23/2020 5:01 PM
TerminationsTermination ReasonInsertNew Registration  7/23/2020 5:01 PM