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DSH060010 POUDRE VALLEY HOSPITAL (Active)
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Main Details
Name
POUDRE VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060010
Medicare Provider Number
060010
Additional Details
Current Program Status
Active
Registration Date
1/10/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/11/2022
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Poudre Valley Health Care, Inc.
David Charles Thompson, Chief Financial Officer
(970) 237-7011
Primary Contact
Poudre Valley Health Care, Inc.
Andrew Harmon, Director of Pharmacy
(970) 495-8054
Addresses
Street Address
1024 S. LEMAY AVENUE
FT. COLLINS, CO 80524
Billing Address
Poudre Valley Health Care Inc.
2315 East Harmony Road
Suite 200
Fort Collins, CO 80528-8620
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2017; Terminated 1/1/2018; Reinstated on 4/1/2022.
03/14/2022
Participated starting 7/1/2017; Terminated 1/1/2018; Reinstated on 3/14/2022.
03/14/2022
Participated starting 7/1/2017; Terminated 1/1/2018; Reinstated on 4/1/2022.
02/11/2022
Hospital started participating in the program as an RRC on 04/01/2015 and was terminated on 04/01/2016. Hospital will begin participation as a DSH hospital on 7/1/17.
06/08/2017
April 2025
April 2025
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