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DSH060010E POUDRE VALLEY HOSPITAL (Active)
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Main Details
Name
POUDRE VALLEY HOSPITAL
Subdivision Name
Breast Diagnostic Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060010E
Medicare Provider Number
060010
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/8/2022
Participating Start Date
4/1/2022
Participating Approval Date
3/10/2022
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
2127 East Harmony Road
Suite 100
Fort Collins, CO 80528-3405
Billing Address
Poudre Valley Health Care Inc
2315 E Harmony Road
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 on 1/1/2018; Reinstated on 4/1/2022.
03/10/2022
May 2025
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