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DSH320021CM PRESBYTERIAN HOSPITAL (Terminated)
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Main Details
Name
PRESBYTERIAN HOSPITAL
Subdivision Name
PMG Alameda Urgent Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320021CM
Medicare Provider Number
320021
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/12/2015
Last Recertification Date
8/26/2016
Termination Date
Termination Reason
1/1/2017
Site closure
Contacts
Authorizing Official
Presbyterian Healthcare Services
David Scott Graham, VP-PDS Clinical Support Srvc
(505) 841-1872
Primary Contact
Presbyterian Hospital
Sara Matlock, Pharmacy Business Associate
(505) 724-8981
Addresses
Street Address
1648 Alameda Blvd NW
Albuquerque, NM 87110
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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