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DSH060064 Centura Porter Adventist Hospital (Terminated)
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Main Details
Name
Centura Porter Adventist Hospital
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060064
Medicare Provider Number
060064
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/27/2022
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
7/1/2023
Change of covered entity type
Contacts
Authorizing Official
Centura Health
Andrew Whitlock, CFO
(303) 673-1256
Primary Contact
CommonSpirit Health
Samantha Morgan, System Manager, 340B Mountain Region
(303) 673-7380
Addresses
Street Address
2525 SOUTH DOWNING STREET
DENVER, CO 80210
Billing Address
Centura Health
PO Box 372660
Denver, CO 80237
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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