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DSH060008W SAN LUIS VALLEY REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
SAN LUIS VALLEY REGIONAL MEDICAL CENTER
Subdivision Name
SLV Health La Jara Rural Health Clinic/ OB/GYN - OB/GYN
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH060008W
Medicare Provider Number
060008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/25/2020
Last Recertification Date
8/21/2020
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
San Luis Valley Regional Medical Center
Konnie Martin, CEO
(719) 587-1202
Primary Contact
San Luis Valley Regional Medical Center
Sadie Spencer, Director of Pharmacy
(719) 587-1261
Addresses
Street Address
509 Main Street
La Jara, CO 81140
Billing Address
San Luis Valley Regional Medical Center
106 Blanca Avenue
Alamosa, CO 81101
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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