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DSH320002 ST. VINCENT HOSPITAL (Active)
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Main Details
Name
ST. VINCENT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320002
Medicare Provider Number
320002
Additional Details
Current Program Status
Active
Registration Date
7/16/2008
Participating Start Date
1/1/2014
Participating Approval Date
7/16/2008
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
455 ST. MICHAELS DRIVE
SANTA FE, NM 87505
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/19/13 enrolled 10/1/2004 thru 9/30/13, not enrolled 10/1/13 thru 12/31/13 due to failure to recertify, reinstated based on on-line registration submitted in Oct. 2013; 6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS
11/19/2013
6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS
07/06/2011
6/27/2011- DOC. RECD. TO CONFIRM NON-PROFIT STATUS 3/31/10 DOC RECD TO CONFIRM ELIG NON-PROFIT STATUS
07/06/2011
May 2025
May 2025
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