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DSH060023B ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. (Terminated)
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Main Details
Name
ST. MARY'S HOSPITAL & MEDICAL CENTER, INC.
Subdivision Name
ST MARYS NEPHROLOGY CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH060023B
Medicare Provider Number
060023
Outpatient Facility Provider Number
060023
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/3/2014
Last Recertification Date
9/6/2022
Termination Date
Termination Reason
1/1/2023
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
SCL Health
Terri Chinn, VP of Finance
(970) 298-2020
Primary Contact
SCL Health
Rudy E Bormann, Director of Pharmacy
(970) 298-2460
Addresses
Street Address
2635 N. 7TH STREET
ST MARYS NEPHROLOGY CLINIC
GRAND JUNCTION, CO 81501
Billing Address
St Mary's Hospital and Medical Center Inc.
Attn: Accounts Payable
PO Box 1010
Lafayette, CO 80026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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