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DSH060103B Centura Health-Avista Adventist Hospital (Terminated)
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Main Details
Name
Centura Health-Avista Adventist Hospital
Subdivision Name
Church Ranch Neighborhood Health Center / Emergency Department
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060103B
Medicare Provider Number
060103
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/6/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/28/2017
Last Recertification Date
8/29/2019
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
Centura Health
Carol Travis, CFO
(720) 627-1230
Primary Contact
Centura Health
VINNY POLITO, SYSTEM DIRECTOR AMB PHARMACY
(303) 673-1014
Addresses
Street Address
7233 Church Ranch Boulevard
Emergency Department
Westminster, CO 80021
Billing Address
Centura Health
PO Box 372660
Denver, CO 80237
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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