340B Drug Pricing Program Database
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DSH060009J Intermountain Health Lutheran Hospital (Active)
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Main Details
Name
Intermountain Health Lutheran Hospital
Subdivision Name
SCL HEALTH FRONT RANGE INC - LMC Hospice Outpatient
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060009J
Medicare Provider Number
060009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/8/2022
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
SCL Health Lutheran Medical Center
Ashley Denton, VP Finance
(303) 425-2410
Primary Contact
Intermountain Health
Ben Landry, 340B Pharmacist
(207) 200-5264
Addresses
Street Address
3210 LUTHERAN PKWY
PALLIATIVE CARE SERVICES
WHEAT RIDGE, CO 80033-6019
Billing Address
Lutheran Medical Center ATTN: Accounts Payable
P.O. 1010
Lafayette, CO 80026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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