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CAH291300-00 MT. GRANT GENERAL HOSPITAL (Terminated)
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Main Details
Name
MT. GRANT GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH291300-00
Medicare Provider Number
291300
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/22/2019
Last Recertification Date
Termination Date
Termination Reason
10/1/2020
Failure to recertify
Contacts
Authorizing Official
Mt. Grant General Hospital
Michael Tomislav Metkovich, CFO
(775) 527-3277
Primary Contact
Mt. Grant General Hospital
Greg Schumann, IT-Mgr
(775) 945-2461
Addresses
Street Address
1ST AND A STREETS
HAWTHORNE, NV 89415
Billing Address
Mt Grant General Hospital
PO Box 1510
Hawthorne, NV 89415-1510
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2018, terminated 10/1/2019. Reinstated 1/1/2020.
10/18/2019
Participated starting 4/1/2013, terminated 1/1/2018. Reinstated 4/1/2018.
01/17/2018
May 2025
May 2025
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