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DSH060008L SAN LUIS VALLEY REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
SAN LUIS VALLEY REGIONAL MEDICAL CENTER
Subdivision Name
SLV Health Stuart Avenue Clinic / Internal Medicine Primary Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH060008L
Medicare Provider Number
060008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/12/2016
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
7/1/2019
Other
Contacts
Authorizing Official
San Luis Valley Regional Medical Center
Konnie Martin, CEO
(719) 587-1202
Primary Contact
San Luis Valley Reg. Med Ctr
Lee Hankins, Pharmacy Director
(719) 587-1261 Ext: 1261
Addresses
Street Address
2115 Stuart Avenue
Alamosa, CO 81101
Billing Address
San Luis Valley Regional Medical Center
106 Blanca Avenue
Alamosa, CO 81101
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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