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DSH320021DA PRESBYTERIAN HOSPITAL (Terminated)
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Main Details
Name
PRESBYTERIAN HOSPITAL
Subdivision Name
Presbyterian Heart Group - Presbyteran Medical Group Kaseman Cardiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320021DA
Medicare Provider Number
320021
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/11/2016
Last Recertification Date
9/14/2020
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
Presbyterian Healthcare Services
David Scott Graham, VP-PDS Clinical Support Srvc
(505) 841-1872
Primary Contact
Presbyterian Healthcare Services
Kelly Green, 340B Program Manager
(505) 724-7761
Addresses
Street Address
8300 Constitution NE
Bldg D
Albquerque, NM 87110
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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