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DSH320001DA UNIVERSITY OF NEW MEXICO HOSPITAL (Terminated)
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Main Details
Name
UNIVERSITY OF NEW MEXICO HOSPITAL
Subdivision Name
Adult Infusion Clinic - Stem Cell Transplant Program
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH320001DA
Medicare Provider Number
320001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/5/2018
Last Recertification Date
9/11/2020
Termination Date
Termination Reason
4/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
UNM Hospitals
Bonnie White, Chief Financial Officer
(505) 272-1840
Primary Contact
UNM Hospital
Louis E Achusim, Executive Director of Pharmacy
(505) 272-2038
Addresses
Street Address
1201 CAMINO DE SALUD NE
Fourth Floor
Albuquerque, NM 87102
Billing Address
University of New Mexico Hospital
PO Box 80600
Albuquerque, NM 87198
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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