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DSH060009A Intermountain Health Lutheran Hospital (Active)
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Main Details
Name
Intermountain Health Lutheran Hospital
Subdivision Name
Lutheran Medical Center - Cancer Centers of Colorado - Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060009A
Medicare Provider Number
060009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/4/2015
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
400 Indiana Street, Ste 310
INFUSION CENTER
Golden, CO 80401-6013
Billing Address
LUTHERAN MEDICAL CENTER
P.O. Box 1010
Lafayette, CO 80026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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