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DSH320001AP UNIVERSITY OF NEW MEXICO HOSPITAL (Terminated)
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Main Details
Name
UNIVERSITY OF NEW MEXICO HOSPITAL
Subdivision Name
Coumadin Anticoagulation Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH320001AP
Medicare Provider Number
320001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/14/2013
Last Recertification Date
9/9/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
UNM Hospitals
Bonnie White, Chief Financial Officer
(505) 272-1840
Primary Contact
UNM Hospital
Louis E Achusim, Executive Director of Pharmacy
(505) 272-2038
Addresses
Street Address
4808 McMahon Blvd NW
Albuquerque, NM 87114
Billing Address
University of New Mexico Hospital
PO Box 80600
Albuquerque, NM 87198-0600
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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