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DSH320004X GERALD CHAMPION REGIONAL MEDICAL CTR (Terminated)
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Main Details
Name
GERALD CHAMPION REGIONAL MEDICAL CTR
Subdivision Name
Champion Health and Wellness Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320004X
Medicare Provider Number
320004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/24/2019
Last Recertification Date
9/14/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Otero County Hospital Association
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841
Primary Contact
Otero County Hospital Associaton
Cheri Christine Moore, Financial Analyst
(575) 443-7841
Addresses
Street Address
1212 9th Street
Suite B-C
Alamogordo, NM 88310-5842
Billing Address
Gerald Champion Regional Medical Center
2669 Scenic Drive
Alamogordo, NM 88310-8734
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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