Covered Entity Details

DSH030006U TUCSON MEDICAL CENTER (Approved) - information as of 6/14/2025 10:10:00 AM

Main Details

Name

TUCSON MEDICAL CENTER

Subdivision Name

TMC Rincon Radiology - TMC Rincon Radiology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH030006U

Medicare Provider Number

030006

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/4/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/16/2025

Last Recertification Date

Contacts

Authorizing Official

TMCH
Steve Reichling, CFO
(520) 327-5461

Primary Contact

Tucson Medical Center
Claudia Lorraine Koreny, Director of Pharmacy
(520) 324-2317

Addresses

Street Address

5755 S Houghton Road
Tucson, AZ 85747

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?
No

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
DSH030006A	Child	DSH	TUCSON MEDICAL CENTER	Outpatient Procedure Center	1400 N Wilmot	Tucson	AZ	Active
DSH030006B	Child	DSH	TUCSON MEDICAL CENTER	Tucson Medical Center / Cardiac Rehab	1400 N Wilmot Road	Tucson	AZ	Active
DSH030006C	Child	DSH	TUCSON MEDICAL CENTER	Tucson Medical Center / Wound Clinic	1400 N Wilmot Rd	Tucson	AZ	Active
DSH030006D	Child	DSH	TUCSON MEDICAL CENTER	TUCSON MEDICAL CENTER / Pain Clinic	5355 E. Erickson	TUCSON	AZ	Active
DSH030006E	Child	DSH	TUCSON MEDICAL CENTER	Peppi's House	2715 N Wyatt Drive	Tucson	AZ	Active
DSH030006F	Child	DSH	TUCSON MEDICAL CENTER	TMC Outpatient Surgery Center	2424 North Wyatt Drive	Tucson	AZ	Terminated
DSH030006G	Child	DSH	TUCSON MEDICAL CENTER	Rincon Infusion Center	10350 E Drexel Road, Suite 160	Tucson	AZ	Terminated
DSH030006H	Child	DSH	TUCSON MEDICAL CENTER	TMC PULMONOLOGY - TMC Pulmonology	1951 N WILMOT RD	TUCSON	AZ	Active
DSH030006J	Child	DSH	TUCSON MEDICAL CENTER	TMC ENDOCRINOLOGY - TMC Endocrinology	2380 N FERGUSON AVE	TUCSON	AZ	Active
DSH030006K	Child	DSH	TUCSON MEDICAL CENTER	TMC RHEUMATOLOGY - TMC Rheumatology	2380 N FERGUSON AVE	TUCSON	AZ	Active
DSH030006L	Child	DSH	TUCSON MEDICAL CENTER	TMC Multispecialty Rheumatology - TMC Multispecialty Rheumatology	1396 N Wilmot Road	Tucson	AZ	Active
DSH030006M	Child	DSH	TUCSON MEDICAL CENTER	TMC Rincon Cath Lab - TMC Rincon Cath Lab	5755 S Houghton Road	Tucson	AZ	Approved
DSH030006N	Child	DSH	TUCSON MEDICAL CENTER	TMC Oncology Infusion West - TMC Oncology Infusion West	5301 E Grant Road	Tucson	AZ	Approved
DSH030006P	Child	DSH	TUCSON MEDICAL CENTER	TMC Oncology Infusion East - TMC Oncology Infusion East	5301 E Grant Road	Tucson	AZ	Approved
DSH030006Q	Child	DSH	TUCSON MEDICAL CENTER	TMC Rincon Physical Therapy - TMC Rincon Physical Therapy	5755 S Houghton Road	Tucson	AZ	Approved
DSH030006R	Child	DSH	TUCSON MEDICAL CENTER	TMC Rincon Respiratory Therapy - TMC Rincon Respiratory Therapy	5755 S Houghton Road	Tucson	AZ	Approved
DSH030006S	Child	DSH	TUCSON MEDICAL CENTER	TMC Rincon OR - TMC Rincon OR	5755 S Houghton Road	Tucson	AZ	Approved
DSH030006T	Child	DSH	TUCSON MEDICAL CENTER	TMC Rincon ED - TMC Rincon ED	5755 S Houghton Road	Tucson	AZ	Approved
DSH030006U	Child	DSH	TUCSON MEDICAL CENTER	TMC Rincon Radiology - TMC Rincon Radiology	5755 S Houghton Road	Tucson	AZ	Approved
DSH030006V	Child	DSH	TUCSON MEDICAL CENTER	TMC Rincon Lab - TMC Rincon Lab	5755 S Houghton Road	Tucson	AZ	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Reichling, Steve CFO TMCH 5203275461	4/16/2025 7:52 AM
Details	340B ID	Update	New Registration		DSH030006U	4/16/2025 7:52 AM
Details	Entity Subname	Update	New Registration	TMC Rincon Radiology	TMC Rincon Radiology - TMC Rincon Radiology	4/16/2025 7:52 AM
Dates	Participating Approval Date	Update	New Registration		4/16/2025 7:52:57 AM	4/16/2025 7:52 AM
Details	State	Update	New Registration	Pending	Approved	4/16/2025 7:52 AM
Dates	Signed By Date	Update	New Registration		4/8/2025 12:57:08 PM	4/16/2025 7:52 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/16/2025 7:52 AM
Addresses	Main Address	Insert	New Registration		5755 S Houghton Road Tucson, AZ 85747	4/4/2025 3:08 PM
Contacts	Primary Contact	Insert	New Registration		Koreny, Claudia Lorraine Director of Pharmacy Tucson Medical Center 5203242317	4/4/2025 3:08 PM
Contacts	Authorizing Official	Insert	New Registration		Reichling, Steve CFO TMCH 5203275461	4/4/2025 3:08 PM
Details	Assistance Received From Date	Insert	New Registration			4/4/2025 3:08 PM
Details	Assistance Received To Date	Insert	New Registration			4/4/2025 3:08 PM
Details	Last Recertification Date	Insert	New Registration			4/4/2025 3:08 PM
Details	Grant Number	Insert	New Registration			4/4/2025 3:08 PM
Details	340B ID	Insert	New Registration			4/4/2025 3:08 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2025 3:08 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2025 3:08 PM
Details	Medicare Provider Number	Insert	New Registration		030006	4/4/2025 3:08 PM
Details	Entity Name	Insert	New Registration		TUCSON MEDICAL CENTER	4/4/2025 3:08 PM
Details	NOFO Number	Insert	New Registration			4/4/2025 3:08 PM
Details	Program Code	Insert	New Registration		DSH	4/4/2025 3:08 PM
Details	Entity Subname	Insert	New Registration		TMC Rincon Radiology	4/4/2025 3:08 PM
Dates	Participating Approval Date	Insert	New Registration			4/4/2025 3:08 PM
Details	State	Insert	New Registration		Pending	4/4/2025 3:08 PM
Dates	Registration Date	Insert	New Registration		4/4/2025 3:08:06 PM	4/4/2025 3:08 PM
Dates	Signed By Date	Insert	New Registration			4/4/2025 3:08 PM
Dates	Start Date	Insert	New Registration			4/4/2025 3:08 PM
Terminations	Termination Comments	Insert	New Registration			4/4/2025 3:08 PM
Terminations	Termination Date	Insert	New Registration			4/4/2025 3:08 PM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2025 3:08 PM
Terminations	Termination Reason	Insert	New Registration			4/4/2025 3:08 PM