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DSH320002Z ST. VINCENT HOSPITAL (Active)
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Main Details
Name
ST. VINCENT HOSPITAL
Subdivision Name
CHRISTUS St. Vincent Urology - Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320002Z
Medicare Provider Number
320002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/9/2024
Participating Start Date
4/1/2024
Participating Approval Date
3/5/2024
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
St. Vincent Hospital
Lillian Montoya, President and CEO
(505) 913-5258
Primary Contact
St. Vincent Hospital
Christine Atwell, Director of Pharmacy
(505) 913-5522
Addresses
Street Address
465 SAINT MICHAELS DR
STE 110
SANTA FE, NM 87505-7670
Billing Address
ST. VINCENT HOSPITAL
455 ST. MICHAELS DRIVE
SANTA FE, NM 87505
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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