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DSH060023E ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. (Terminated)
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Main Details
Name
ST. MARY'S HOSPITAL & MEDICAL CENTER, INC.
Subdivision Name
ST. MARY'S LIFE CENTER - Occupational Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH060023E
Medicare Provider Number
060023
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/13/2015
Last Recertification Date
11/20/2017
Termination Date
Termination Reason
4/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
SCL Health
Terri Chinn, CFO
(970) 298-2020
Primary Contact
SCL Health
Rudy E Bormann, Director of Pharmacy
(970) 298-2460
Addresses
Street Address
2686 PATTERSON RD
GRAND JUNCTION, CO 81506-8817
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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