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DSH320002W ST. VINCENT HOSPITAL (Terminated)
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Main Details
Name
ST. VINCENT HOSPITAL
Subdivision Name
CHRISTUS ST VINCENT MEDICATION MANAGEMENT SERVICES CLINIC - MEDICATION MANAGEMENT SERVICES CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320002W
Medicare Provider Number
320002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/10/2023
Last Recertification Date
Termination Date
Termination Reason
4/1/2023
Other
Contacts
Authorizing Official
St. Vincent Hospital
Lillian Montoya, President and CEO
(505) 913-5258
Primary Contact
St. Vincent Hospital
Christine Atwell, Director of Pharmacy
(505) 913-5522
Addresses
Street Address
465 SAINT MICHAELS DR
STE 114
Santa Fe, NM 87505
Billing Address
ST. VINCENT HOSPITAL
455 ST. MICHAELS DRIVE
SANTA FE, NM 87505
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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