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DSH060009B LUTHERAN MEDICAL CENTER (Terminated)
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Main Details
Name
LUTHERAN MEDICAL CENTER
Subdivision Name
LMC Pulmonary Rehabilitation
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060009B
Medicare Provider Number
060009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/4/2015
Last Recertification Date
8/16/2018
Termination Date
Termination Reason
1/1/2019
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Lutheran Medical Center
Sean Fadden, VP, Finance
(303) 425-2410
Primary Contact
Lutheran Medical Center
Jason Cardona, Director of Pharmacy
(303) 425-2049
Addresses
Street Address
9830 I-70 FRONTAGE RD S
PULMONARY REHABILITATION
WHEAT RIDGE, CO 80033
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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