340B Drug Pricing Program Database
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DSH320021BP PRESBYTERIAN HOSPITAL (Terminated)
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Main Details
Name
PRESBYTERIAN HOSPITAL
Subdivision Name
Las Estancias Internal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320021BP
Medicare Provider Number
320021
Outpatient Facility Provider Number
320021
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
Last Recertification Date
9/16/2022
Termination Date
Termination Reason
4/1/2023
Site closure
Contacts
Authorizing Official
Presbyterian Healthcare Services
Erica Downing, VP, Pharmacy and Infusion Services & Chief Pharmacy Officer
(505) 724-8994
Primary Contact
Presbyterian Healthcare Services
Kelly Green, 340B Program Manager
(505) 724-7761
Addresses
Street Address
3630 Las Estancias Dr. SW
Albuquerque, NM 87121
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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