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DSH320004L GERALD CHAMPION REGIONAL MEDICAL CTR (Terminated)
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Main Details
Name
GERALD CHAMPION REGIONAL MEDICAL CTR
Subdivision Name
Women's Specialty Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320004L
Medicare Provider Number
320004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
Last Recertification Date
9/6/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Otero County Hospital Association
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841
Primary Contact
Otero County Hospital Associaton
Cheri Christine Moore, Financial Analyst
(575) 443-7841
Addresses
Street Address
2050 NORTH SCENIC DRIVE
ALAMOGORDO, NM 88310-3880
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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