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CAH061323-04 PROWERS MEDICAL CENTER (Active)
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Main Details
Name
PROWERS MEDICAL CENTER
Subdivision Name
PROWERS COUNTY HOSPITAL DISTRICT - OUTPATIENT CLINIC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH061323-04
Medicare Provider Number
061323
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/13/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/24/2018
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Prowers Medical Center
Steven A Gilgen, CFO
(719) 336-6753
Primary Contact
Prowers Medical Center
ROBIN THACKER, PHARMACIST
(719) 336-6740
Addresses
Street Address
403 KENDALL DRIVE
LAMAR, CO 81052
Billing Address
PROWERS MEDICAL CENTER
401 KENDALL DRIVE
LAMAR, CO 81052
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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