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DSH060009K Intermountain Health Lutheran Hospital (Terminated)
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Main Details
Name
Intermountain Health Lutheran Hospital
Subdivision Name
SCL HEALTH FRONT RANGE INC - Chemical Dependency Intensive Outpatient Program
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH060009K
Medicare Provider Number
060009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2022
Participating Start Date
11/8/2022
Participating Approval Date
10/5/2022
Last Recertification Date
8/20/2024
Termination Date
Termination Reason
4/1/2025
Site closure
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
3400 LUTHERAN PKWY
WEST PINES BEHAVIORAL HEALTH
WHEAT RIDGE, CO 80033-6035
Billing Address
Lutheran Medical Center Attn: Accounts Payable
PO Box 1010
Lafayette, CO 80026
Comments
Medicaid Billing
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April 2025
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