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DSH170122Q Via Christi Hospitals Wichita, Inc (Terminated)
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Main Details
Name
Via Christi Hospitals Wichita, Inc
Subdivision Name
SJC Rad Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170122Q
Medicare Provider Number
170122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/20/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/27/2013
Last Recertification Date
9/5/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Via Christi Hospitals Wichita, Inc
Jim C Garrelts, Vice President, Pharmacy
(316) 268-5580
Primary Contact
Via Christi Hospitals Wichita, Inc.
Jim Garrelts, Senior Director of Pharmacy
(316) 268-5580
Addresses
Street Address
3600 East Harry
Wichita, KS 67218
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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