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DSH030013AK YUMA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
YRMCPLZ SURGICAL SVC: 74210 - Outpatient Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030013AK
Medicare Provider Number
030013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/2/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/2/2020
Last Recertification Date
Termination Date
Termination Reason
7/1/2020
Terminated - Reason unknown
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
2460 S PARKVIEW LOOP
2400 S Ave A
Suite 1
Yuma, AZ 85364
Billing Address
Yuma Regional Medical Center
C/O AP
2400 S Ave A
Yuma, AZ 85364
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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