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DSH060008R SAN LUIS VALLEY REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
SAN LUIS VALLEY REGIONAL MEDICAL CENTER
Subdivision Name
SLV Health Antonito Rural Health Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH060008R
Medicare Provider Number
060008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/22/2017
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
San Luis Valley Regional Medical Center
Konnie Martin, CEO
(719) 587-1202
Primary Contact
San Luis Valley Health
Thomas Robert Wisniewski, Director of Pharmacy
(719) 587-1261
Addresses
Street Address
115 Main Street
Antonito, CO 81120
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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