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DSH170122AA Ascension Via Christi Hospitals Wichita, Inc (Terminated)
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Main Details
Name
Ascension Via Christi Hospitals Wichita, Inc
Subdivision Name
VIA CHRISTI HOSPITALS WICHITA, INC. / Specialty Clinic Psych
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170122AA
Medicare Provider Number
170122
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/5/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/16/2016
Last Recertification Date
9/3/2019
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
Via Christi Hospitals Wichita, Inc
Jim C Garrelts, Vice President, Pharmacy
(316) 268-5580
Primary Contact
Ascension Via Christi Hospitals Wichita, Inc.
Sarah E Dodson, 340B Program Director
(316) 202-8759
Addresses
Street Address
1515 South Clifton Ave
WICHITA, KS 67218
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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