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DSH060022 Memorial Health System (Active)
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Main Details
Name
Memorial Health System
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060022
Medicare Provider Number
060022
Additional Details
Current Program Status
Active
Registration Date
4/21/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/21/2008
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
UCHealth
Gregory Harden, CFO
(719) 365-1820
Primary Contact
Memorial Health System
Christopher P Martin, Director of Pharmacy
(719) 365-9381
Addresses
Street Address
1400 EAST BOULDER STREET
COLORADO SPRINGS, CO 80909
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Last Updated On
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02/09/2012 removed medicaid # (was 05022009);1-25-12 - CONTACT PERSON CHANGED,2/25/09 - DOCUMENTS RECD TO CONFIRM ELIGIBLE DSH ADJ%
02/09/2012
1-25-12 - CONTACT PERSON CHANGED,2/25/09 - DOCUMENTS RECD TO CONFIRM ELIGIBLE DSH ADJ%
01/25/2012
2/25/09 - DOCUMENTS RECD TO CONFIRM ELIGIBLE DSH ADJ%
03/11/2009
April 2025
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