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DSH060009E Intermountain Health Lutheran Hospital (Active)
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Main Details
Name
Intermountain Health Lutheran Hospital
Subdivision Name
Lutheran Medical Center - Cancer Centers of Colorado - Medical Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060009E
Medicare Provider Number
060009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/2/2018
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
SCL Health Lutheran Medical Center
Ashley Denton, VP Finance
(303) 425-2410
Primary Contact
Intermountain Health
Ben Landry, 340B Pharmacist
(207) 200-5264
Addresses
Street Address
400 Indiana Street, Ste 300
Lutheran Medical Oncology
Golden, CO 80401-6013
Billing Address
Lutheran Medical Center ATTN: Accounts Payable
P.O. 1010
Lafayette, CO 80026
Comments
Medicaid Billing
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