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DSH320004AG GERALD CHAMPION REGIONAL MEDICAL CTR (Terminated)
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Main Details
Name
GERALD CHAMPION REGIONAL MEDICAL CTR
Subdivision Name
Champion Pain Management - Alamogordo
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320004AG
Medicare Provider Number
320004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/10/2020
Last Recertification Date
9/11/2020
Termination Date
Termination Reason
10/1/2021
Site closure
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
2474 Indian Wells Road
Suite A
Alamogordo, NM 88310-3845
Billing Address
Gerald Champion Regional Medical Center
2669 SCENIC DR
ALAMOGORDO, NM 88310-8734
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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