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CAH061321-01 Trinidad Area Health Association DBA Mount San Rafael Hospital (Active)
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Main Details
Name
Trinidad Area Health Association DBA Mount San Rafael Hospital
Subdivision Name
Rural Health Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH061321-01
Medicare Provider Number
061321
Outpatient Facility Provider Number
063404
Additional Details
Current Program Status
Active
Registration Date
1/8/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/10/2014
Last Recertification Date
8/17/2024
Contacts
Authorizing Official
Mt San Rafael Hospital
Calvin Carey, CFO
(719) 846-8042
Primary Contact
Trinidad Area Health Association
Monica Montoya, 340B Coordinator
(719) 846-8038
Addresses
Street Address
400 Benedicta Ave
Trinidad, CO 81082
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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