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DSH060008U SAN LUIS VALLEY REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
SAN LUIS VALLEY REGIONAL MEDICAL CENTER
Subdivision Name
SLV Health RMC Clinic / Wound Care - Wound Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH060008U
Medicare Provider Number
060008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/4/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/10/2019
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
San Luis Valley Regional Medical Center
Konnie Martin, CEO
(719) 587-1202
Primary Contact
San Luis Valley Health
Thomas Robert Wisniewski, Director of Pharmacy
(719) 587-1261
Addresses
Street Address
106 Blanca Avenue
Alamosa, CO 81101
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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