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DSH060009 Intermountain Health Lutheran Hospital (Active)
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Main Details
Name
Intermountain Health Lutheran Hospital
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060009
Medicare Provider Number
060009
Additional Details
Current Program Status
Active
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/10/2015
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
SCL Health Lutheran Medical Center
Ashley Denton, VP Finance
(303) 425-2410
Primary Contact
Intermountain Health
Ben Landry, 340B Pharmacist
(207) 200-5264
Addresses
Street Address
12911 W 40th Ave
WHEAT RIDGE, CO 80401
Billing Address
Intermountain Health Lutheran Hospital
P.O. Box 1010
Lafayette, CO 80026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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