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SCH530002-00 CAMPBELL COUNTY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
CAMPBELL COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
No
340B ID
SCH530002-00
Medicare Provider Number
530002
Additional Details
Current Program Status
Terminated
Registration Date
4/5/2016
Participating Start Date
3/15/2022
Participating Approval Date
5/9/2016
Last Recertification Date
9/26/2023
Termination Date
Termination Reason
4/1/2024
DSH percentage below statutory minimum
Contacts
Authorizing Official
Campbell County Memorial Hospital
Matthew Shahan, CEO
(307) 688-1551
Primary Contact
Campbell County Health
Kirsi Maria Ludwig, Pharmacy Director
(307) 688-3271
Addresses
Street Address
501 S BURMA AVENUE
GILLETTE, WY 82717-3011
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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