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CH06345E PRESBYTERIAN MEDICAL SERVICES (Terminated)
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Main Details
Name
PRESBYTERIAN MEDICAL SERVICES
Subdivision Name
JEMEZ VALLEY MEDICAL CLINIC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-004941
340B ID
CH06345E
Grant Number
H80CS00205
Additional Details
Current Program Status
Terminated
Registration Date
12/1/1992
Participating Start Date
12/1/1992
Participating Approval Date
8/26/2004
Last Recertification Date
1/30/2019
Termination Date
Termination Reason
4/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Presbyterian Medical Services
Stephen M. Quesada, DIRECTOR OF PHARMACY
(505) 443-2634
Primary Contact
Presbyterian Medical Services
Steven C. Hansen, CEO
(505) 982-5565 Ext: 3470
Addresses
Street Address
8372 State HIGHWAY 4
Canon, NM 87024-9727
Billing Address
PRESBYTERIAN MEDICAL SERVICES
1422 PASEO DE PERALTA
SANTA FE, NM 87501
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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9/24/2008-UPDATED BILLING ADD. (WAS PO BOX 2267);2/27/07 - UPDATED NAME (WAS JEMEZ SPRINGS CLINIC)
09/24/2008
June 2025
June 2025
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