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DSH030013AS YUMA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
Pediatric Urology: 70920 - Urology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030013AS
Medicare Provider Number
030013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/28/2020
Last Recertification Date
Termination Date
Termination Reason
7/1/2020
Other
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
2851 S. Ave B, Bldg. 25,
Suite 2504
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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