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DSH060009C Intermountain Health Lutheran Hospital (Terminated)
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Main Details
Name
Intermountain Health Lutheran Hospital
Subdivision Name
WEST PINES BEHAVIORAL HEALTH
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060009C
Medicare Provider Number
060009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/30/2015
Last Recertification Date
8/20/2024
Termination Date
Termination Reason
4/1/2025
Site closure
Contacts
Authorizing Official
SCL Health Lutheran Medical Center
Ashley Denton, VP Finance
(303) 425-2410
Primary Contact
Intermountain Health
Ben Landry, 340B Pharmacist
(207) 200-5264
Addresses
Street Address
3400 LUTHERAN PKWY
WHEAT RIDGE, CO 80033-6035
Billing Address
Lutheran Medical Center ATTN: Accounts Payable
P.O. 1010
Lafayette, CO 80026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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