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DSH030062 SUMMIT HEALTHCARE ASSOCIATION DBA SUMMIT HEALTHCARE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
SUMMIT HEALTHCARE ASSOCIATION DBA SUMMIT HEALTHCARE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030062
Medicare Provider Number
030062
Additional Details
Current Program Status
Active
Registration Date
12/9/2008
Participating Start Date
1/1/2009
Participating Approval Date
12/10/2008
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Summit Healthcare
William Carroll Gardner, Chief Clinical Officer
(928) 537-6932
Primary Contact
Summit Healthcare
Edward Kraig Muder, Director of Pharmacy
(928) 537-6321
Addresses
Street Address
2200 EAST SHOW LOW LAKE ROAD
SHOW LOW, AZ 85901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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