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DSH060071 DELTA COUNTY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
DELTA COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH060071
Medicare Provider Number
060071
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/11/2018
Last Recertification Date
8/23/2018
Termination Date
Termination Reason
7/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Delta County Memorial Hospital
Jason Cleckler, CEO
(970) 874-2229
Primary Contact
Delta County Memorial Hospital
Mark Carlton, Pharmacy Director
(970) 874-2202
Addresses
Street Address
1501 E. 3RD ST.
DELTA, CO 81416
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2016; Terminated 1/1/2018; Reinstated 7/1/2018.
05/01/2018
April 2025
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