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DSH060009L Intermountain Health Lutheran Hospital (Active)
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Main Details
Name
Intermountain Health Lutheran Hospital
Subdivision Name
Coumadin Clinic - Ambulatory Clinical Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060009L
Medicare Provider Number
060009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
Contacts
Authorizing Official
SCL Health Lutheran Medical Center
Ashley Denton, VP Finance
(303) 425-2410
Primary Contact
Intermountain Health
Ben Landry, 340B Pharmacist
(207) 200-5264
Addresses
Street Address
2905 W 40th Ave, Suite 215
Wheat Ridge, CO 80401
Billing Address
Intermountain Health Lutheran Medical Center
PO BOX 1010
LAFAYETTE, CO 80026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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