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DSH060036 Arkansas Valley Regional Medical Center (Terminated)
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Main Details
Name
Arkansas Valley Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH060036
Medicare Provider Number
060036
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/13/2014
Last Recertification Date
8/18/2016
Termination Date
Termination Reason
7/1/2017
Change of covered entity type
Contacts
Authorizing Official
Arkansas Valley Regional Medical Center
Lynn Crowell, Chief Executive Officer
(719) 383-6000
Primary Contact
Janette Bender, CFO
(719) 383-6026
Addresses
Street Address
1100 Carson Avenue
La Junta, CO 81050
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/25/17 participating 7/1/2014 until terminated effective 7/1/17 due to change of hospital type to CAH (CAH061336-00)
04/25/2017
May 2025
May 2025
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