Covered Entity Details

DSH100113AP SHANDS TEACHING HOSPITAL AND CLINICS, INC. (Active) - information as of 5/5/2025 12:05:38 AM

Main Details

Name

SHANDS TEACHING HOSPITAL AND CLINICS, INC.

Subdivision Name

UF Health Center for Advanced Therapeutics - Radiology Therapeutic

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100113AP

Medicare Provider Number

100113

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/14/2025

Participating Start Date

4/1/2025

Participating Approval Date

1/27/2025

Last Recertification Date

Contacts

Authorizing Official

Shands Teaching Hospital & Clinics Inc
Traci d'Auguste, Chief Operating Officer
(352) 294-8661

Primary Contact

Shands Teaching Hospital & Clinics, Inc.
Thomas Johns, Associate Vice President, Operations
(352) 594-1321

Addresses

Street Address

2004 Mowry Road
Suite 1100
Gainesville, FL 32610

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
FL	010003000,010003004	1699874248,1588765861
GA	000100724A	1699874248,1588765861

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH100113A	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	SHANDS CANCER CENTER, UNIVERSITY OF FLORIDA	2000 SW ARCHER ROAD	GAINESVILLE	FL	Terminated
DSH100113AA	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Endoscopy Suite - ST - Gastroenterology	1515 SW Archer Rd	Gainesville	FL	Active
DSH100113AB	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Radiology - Oaks - Radiology	6201 W Newberry Rd	Gainesville	FL	Active
DSH100113AC	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Diagnostic Imaging-Springhill - RADIOLOGY - DIAGNOSTIC	4037 NW 86th Terrace	Gainesville	FL	Active
DSH100113AD	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Bronchoscopy and Pulmonary Pro - RESPIRATORY THERAPY	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AE	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Radiology - Fixel - RADIOLOGY - DIAGNOSTIC	3009 SW Williston Road	Gainesville	FL	Active
DSH100113AF	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Pediatric Infusion Center - RADIOLOGY - THERAPEUTIC	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AG	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Pediatric Cath Lab - CARDIAC CATHETERIZATION	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AH	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Cardiac Catheterization Lab - CARDIAC CATHETERIZATION	1505 SW Archer Rd	Gainesville	FL	Active
DSH100113AJ	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Burn Outpatient - BURN CLINIC SHANDS@UF	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AK	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	EP Lab - ELECTROCARDIOLOGY	1505 SW Archer Rd	Gainesville	FL	Active
DSH100113AL	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Pulmonary Functions Lab - RESPIRATORY THERAPY	1549 Gale Lemerand Dr	Gainesville	FL	Active
DSH100113AM	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Endoscopy Suite - NT - GI	1600 SW Archer Rd	Gainesville	FL	Active
DSH100113AN	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Mobile Stroke Treatment Unit - Ambulance Services	3300 SW Williston Road	Gainesville	FL	Active
DSH100113AP	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Center for Advanced Therapeutics - Radiology Therapeutic	2004 Mowry Road	Gainesville	FL	Active
DSH100113B	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Dialysis Center	2409 SW Archer Road	Gainesville	FL	Active
DSH100113H	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Pain Management	720 SW 2nd Avenue	Gainesville	FL	Active
DSH100113I	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Florida Surgical Center	3480 Hull Road	Gainesville	FL	Active
DSH100113J	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Endoscopy Center	2001 SW 13th Street	Gainesville	FL	Active
DSH100113K	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Psychiatric Hospital	4101 NW 89th Boulevard	Gainesville	FL	Active
DSH100113L	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Emergency Center- Springhill	8475 NW 39th Avenue	Gainesville	FL	Active
DSH100113M	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	Shands Radiology at the Orthopedics & Sports Medicine Institute	3450 Hull Road	Gainesville	FL	Active
DSH100113N	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Infusion Center - Medical Plaza	1549 Gale Lemerand Drive	Gainesville	FL	Active
DSH100113P	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Department of Radiation Oncology	1549 Gale Lemerand Drive	Gainesville	FL	Active
DSH100113Q	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Spine & Sports Intervention Center	4101 NW 89TH BLVD	GAINESVILLE	FL	Terminated
DSH100113R	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Wound Care & Hyperbaric Center	3951 N.W. 48th Terrace	Gainesville	FL	Active
DSH100113S	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Shands Emergency Center - Kanapaha	7405 SW Archer Road	Gainesville	FL	Active
DSH100113T	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health The Oaks - UF Health The Oaks	6201 W Newberry Rd	Gainesville	FL	Active
DSH100113U	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Medical Dermatology - Dermatology	4037 NW 86th Terrace	Gainesville	FL	Active
DSH100113V	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Operating Rooms-ST - Operating Room	1515 SW Archer Rd	Gainesville	FL	Active
DSH100113W	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Operating Rooms-HVN - Operating Room	1505 SW Archer Rd	Gainesville	FL	Active
DSH100113X	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Bone Marrow Transplant Clinic - Radiology	1515 SW Archer Rd	Gainesville	FL	Active
DSH100113Y	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Radiology (MRI) Medical Plaza - Magnetic Resonance Imaging	1549 Gale Lemerand Drive	Gainesville	FL	Active
DSH100113Z	Child	DSH	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	UF Health Adult Emergency - Emergency	1515 SW Archer Rd	Gainesville	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		d'Auguste, Traci Chief Operating Officer Shands Teaching Hospital & Clinics Inc 3522948661	1/27/2025 8:12 AM
Details	340B ID	Update	New Registration		DSH100113AP	1/27/2025 8:12 AM
Details	Entity Name	Update	New Registration	UF HEALTH SHANDS	SHANDS TEACHING HOSPITAL AND CLINICS, INC.	1/27/2025 8:12 AM
Details	Entity Subname	Update	New Registration	UF Health Center for Advanced Therapeutics	UF Health Center for Advanced Therapeutics - Radiology Therapeutic	1/27/2025 8:12 AM
Dates	Participating Approval Date	Update	New Registration		1/27/2025 8:12:22 AM	1/27/2025 8:12 AM
Details	State	Update	New Registration	Pending	Approved	1/27/2025 8:12 AM
Dates	Signed By Date	Update	New Registration		1/15/2025 12:18:02 PM	1/27/2025 8:12 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	1/27/2025 8:12 AM
Addresses	Main Address	Insert	New Registration		2004 Mowry Road Suite 1100 Gainesville, FL 32610	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010003000	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010003004	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000100724A	1/14/2025 11:18 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		GA	1/14/2025 11:18 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1699874248	1/14/2025 11:18 AM
Medicaid Billing	NPI: State	Insert	New Registration		FL	1/14/2025 11:18 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1588765861	1/14/2025 11:18 AM
Medicaid Billing	NPI: State	Insert	New Registration		FL	1/14/2025 11:18 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1699874248	1/14/2025 11:18 AM
Medicaid Billing	NPI: State	Insert	New Registration		GA	1/14/2025 11:18 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1588765861	1/14/2025 11:18 AM
Medicaid Billing	NPI: State	Insert	New Registration		GA	1/14/2025 11:18 AM
Contacts	Primary Contact	Insert	New Registration		Johns, Thomas Associate Vice President, Operations Shands Teaching Hospital & Clinics, Inc. 3525941321	1/14/2025 11:18 AM
Contacts	Authorizing Official	Insert	New Registration		d'Auguste, Traci Chief Operating Officer Shands Teaching Hospital & Clinics Inc 3522948661	1/14/2025 11:18 AM
Details	Assistance Received From Date	Insert	New Registration			1/14/2025 11:18 AM
Details	Assistance Received To Date	Insert	New Registration			1/14/2025 11:18 AM
Details	Last Recertification Date	Insert	New Registration			1/14/2025 11:18 AM
Details	Grant Number	Insert	New Registration			1/14/2025 11:18 AM
Details	340B ID	Insert	New Registration			1/14/2025 11:18 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2025 11:18 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2025 11:18 AM
Details	Medicare Provider Number	Insert	New Registration		100113	1/14/2025 11:18 AM
Details	Entity Name	Insert	New Registration		UF HEALTH SHANDS	1/14/2025 11:18 AM
Details	NOFO Number	Insert	New Registration			1/14/2025 11:18 AM
Details	Program Code	Insert	New Registration		DSH	1/14/2025 11:18 AM
Details	Entity Subname	Insert	New Registration		UF Health Center for Advanced Therapeutics	1/14/2025 11:18 AM
Dates	Participating Approval Date	Insert	New Registration			1/14/2025 11:18 AM
Details	State	Insert	New Registration		Pending	1/14/2025 11:18 AM
Dates	Registration Date	Insert	New Registration		1/14/2025 11:18:04 AM	1/14/2025 11:18 AM
Dates	Signed By Date	Insert	New Registration			1/14/2025 11:18 AM
Dates	Start Date	Insert	New Registration			1/14/2025 11:18 AM
Terminations	Termination Comments	Insert	New Registration			1/14/2025 11:18 AM
Terminations	Termination Date	Insert	New Registration			1/14/2025 11:18 AM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2025 11:18 AM
Terminations	Termination Reason	Insert	New Registration			1/14/2025 11:18 AM