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DSH320004A GERALD CHAMPION REGIONAL MEDICAL CTR (Terminated)
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Main Details
Name
GERALD CHAMPION REGIONAL MEDICAL CTR
Subdivision Name
AMBULATORY SURGERY CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320004A
Medicare Provider Number
320004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/14/2010
Participating Start Date
4/1/2015
Participating Approval Date
12/14/2010
Last Recertification Date
9/10/2018
Termination Date
Termination Reason
1/1/2019
Other
Contacts
Authorizing Official
Otero County Hospital Association
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841
Primary Contact
Otero County Hospital Associaton
Cheri Christine Moore, Financial Analyst
(575) 443-7841
Addresses
Street Address
2351 25TH STREET
ALAMOGORDO, NM 88310-8722
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
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3/16/15-Previously active as a DSH 1/1/11 through 7/1/12, converted to a SCH from 7/1/12 through 4/1/15. Reinstated as a DSH as of 4/1/15.
03/25/2015
May 2025
May 2025
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Custom
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