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DSH030013R YUMA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
ENDOCRINE CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030013R
Medicare Provider Number
030013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/2/2016
Last Recertification Date
8/23/2018
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
Yuma Regional Medical Center
David Willie, CFO
(928) 336-7015
Primary Contact
Yuma Regional Medical Center
Martin Konopko, 340b Manager
(928) 336-7721
Addresses
Street Address
2851 S Avenue B, Bldg 20
Yuma, AZ 85364
Billing Address
Yuma Regional Medical Center
2400 S Avenue A
Yuma, AZ 85364
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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