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DSH030013AT YUMA REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
YUMA REGIONAL MEDICAL CENTER
Subdivision Name
YRMC Health Clinics - Pediatric GI
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH030013AT
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
8/17/2023
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
Yuma Regional Medical Center
Vernon Moore, Chief Financial Officer
(928) 336-7015
Primary Contact
Yuma Regional Medical Center
Mark Jordan, Directory of Pharmacy
(928) 336-7815
Addresses
Street Address
2851 S. Ave B, Bldg. 25, Suite 2504
70960-10208040
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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