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SCH460019-03 Uintah Basin Medical Center (Active)
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Main Details
Name
Uintah Basin Medical Center
Subdivision Name
UINTAH BASIN MEDICAL CENTER, INC - Duchesne Valley Medical Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH460019-03
Medicare Provider Number
460019
Outpatient Facility Provider Number
463979
Additional Details
Current Program Status
Active
Registration Date
7/8/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/24/2022
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Uintah Basin Medical Center
Brent Hales, CFO
(435) 722-6164
Primary Contact
Uintah Basin Medical Center
Weston Ross Weaver, Outpatient Pharmacy Manager
(435) 722-4691 Ext: 2054
Addresses
Street Address
50 E 200 S
DUCHESNE, UT 84021
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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