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DSH170122X VIA CHRISTI HOSPITAL WICHITA (Terminated)
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Main Details
Name
VIA CHRISTI HOSPITAL WICHITA
Subdivision Name
VIA CHRISTI HOSPITALS WICHITA INC / VC CHF Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170122X
Medicare Provider Number
170122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2015
Participating Start Date
1/1/2016
Participating Approval Date
12/23/2015
Last Recertification Date
8/25/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Via Christi Hospitals Wichita, Inc
Jim C Garrelts, Vice President, Pharmacy
(316) 268-5580
Primary Contact
Via Christi Hospitals Wichita, Inc.
Jim Garrelts, Senior Director of Pharmacy
(316) 268-5580
Addresses
Street Address
848 N ST FRANCIS STE 1900
WICHITA, KS 67214-3841
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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