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DSH030013AF YUMA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
YR PEDIATRICS ARORA 70950 10208005 - Pediatrics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030013AF
Medicare Provider Number
030013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/28/2019
Last Recertification Date
9/8/2020
Termination Date
Termination Reason
7/1/2021
Site closure
Contacts
Authorizing Official
Yuma Regional Medical Center
David Willie, CFO
(928) 336-7015
Primary Contact
Yuma Regional Medical Center
Martin Konopko, 340b Manager
(928) 336-7721
Addresses
Street Address
2500 S 8TH AVE
200
Yuma, AZ 85364
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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