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CAH461306-01 GUNNISON VALLEY HOSPITAL (Approved)
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Main Details
Name
GUNNISON VALLEY HOSPITAL
Subdivision Name
GUNNISON VALLEY HOSPITAL - Main Street Family Clinic RHC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH461306-01
Medicare Provider Number
461306
Outpatient Facility Provider Number
463998
Additional Details
Current Program Status
Approved
Registration Date
4/3/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/4/2025
Last Recertification Date
Contacts
Authorizing Official
Gunnison Valley Hospital
BRIAN C. MURRAY, CFO
(435) 528-2146
Primary Contact
Main Street Family Clinic
Candace Malmgren, Clinic Manager
(435) 893-1029
Addresses
Street Address
156 S MAIN ST
MANTI, UT 84642-1351
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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