Covered Entity Details

DSH100113A SHANDS TEACHING HOSPITAL AND CLINICS, INC. (Terminated) - information as of 6/9/2025 10:58:31 PM

Main Details

Name

SHANDS TEACHING HOSPITAL AND CLINICS, INC.

Subdivision Name

SHANDS CANCER CENTER, UNIVERSITY OF FLORIDA

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100113A

Medicare Provider Number

100113

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

9/14/2007

Participating Start Date

1/1/1995

Participating Approval Date

9/14/2007

Last Recertification Date

8/19/2015

Termination Date
Termination Reason

4/1/2016
Site closure

Contacts

Authorizing Official

Shands Hospital and Teaching Clinics
Edward Jimenez, CEO
(352) 265-0440

Primary Contact

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

Addresses

Street Address

2000 SW ARCHER ROAD
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	010003000,101528100
GA	000100724
		1265514764,1699874248

Shipping Addresses

Shipping Address 1

Shands Cancer Center Pharmacy
2000 SW Archer Road
Room# 2130
Gainesville, FL 32610

Shipping Address 2

Shands Medical Plaza Pharmacy
2000 SW Archer Road
Room #1520
Gainesville, FL 32610

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
Contacts	Primary Contact	Update	Profile Change Request	Johns, Thomas Director, Pharmacy Services Shands Teaching Hospital & Clinics, Inc. 3522650404	Johns, Thomas Associate Vice President, Operations Shands Teaching Hospital & Clinics, Inc. 3525941321	12/21/2023 12:48 PM
Contacts	Authorizing Official	Update		Jimenez, Edward CEO 3522650440	Jimenez, Edward CEO Shands Hospital and Teaching Clinics 3522650440	11/2/2017 11:56 AM
Contacts	Primary Contact	Update		Johns, Thomas Director, Pharmacy Services 3522650404	Johns, Thomas Director, Pharmacy Services Shands Teaching Hospital & Clinics, Inc. 3522650404	10/26/2017 8:28 AM
Contacts	Authorizing Official	Update		KOVAL, CHARLES B. DEPUTY GENERAL COUNSEL AND ASSISTANT SECRETARY 3527330030	Jimenez, Edward CEO 3522650440	7/31/2017 1:38 PM
Contacts	Primary Contact	Update		HARBILAS, BILL ASSISTANT DIRECTOR, PHARMACY SERVICE 3522650404	Johns, Thomas Director, Pharmacy Services 3522650404	8/23/2016 8:13 AM
Dates	Last Date That 340B Drugs Purchased	Update			3/31/2016 12:00:00 AM	2/18/2016 3:18 PM
Details	State	Update		Active	Terminated	2/18/2016 3:18 PM
Terminations	Termination Comments	Update			Adding multiple clinic locations at this address. Therefore, we need to terminate the registration for the building itself.	2/18/2016 3:18 PM
Terminations	Termination Date	Update			4/1/2016 12:00:00 AM	2/18/2016 3:18 PM
Terminations	Termination Effective Date	Update			4/1/2016 12:00:00 AM	2/18/2016 3:18 PM
Terminations	Termination Reason	Update			Site closure	2/18/2016 3:18 PM
Addresses	Main Address	Insert			2000 SW ARCHER ROAD GAINESVILLE, FL 32610	2/18/2016 3:18 PM
Addresses	Shipping Address	Insert			Shands Cancer Center Pharmacy 2000 SW Archer Road Room# 2130 Gainesville, FL 32610	2/18/2016 3:18 PM
Addresses	Shipping Address	Insert			Shands Medical Plaza Pharmacy 2000 SW Archer Road Room #1520 Gainesville, FL 32610	2/18/2016 3:18 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/9/2015 8:47 AM
Medicaid Billing	Medicaid: Number	Insert			000100724	10/9/2015 8:47 AM
Medicaid Billing	Medicaid: State	Insert			GA	10/9/2015 8:47 AM
Details	Last Recertification Date	Update		9/8/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 10:01 AM
Contacts	Primary Contact	Update		Knudsen, Alan K. Director, Pharmacy 3522650404	HARBILAS, BILL ASSISTANT DIRECTOR, PHARMACY SERVICE 3522650404	9/8/2014 5:02 PM
Details	Last Recertification Date	Update		9/9/2013 11:01:55 AM	9/8/2014 12:00:00 AM	9/8/2014 5:02 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/9/2013 11:01:55 AM	9/9/2013 11:01 AM
Contacts	Primary Contact	Insert			Knudsen, Alan K. Director, Pharmacy 3522650404	12/20/2012 4:12 PM
Contacts	Authorizing Official	Insert			KOVAL, CHARLES B. DEPUTY GENERAL COUNSEL AND ASSISTANT SECRETARY 3527330030	8/16/2012 8:37 AM
Dates	Participating Approval Date	Update		9/14/2007 8:47:15 AM	9/14/2007 12:00:00 AM	8/16/2012 8:36 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/1/2012 7:39 AM
Medicaid Billing	Medicaid: Number	Insert			010003000	6/1/2012 7:39 AM
Medicaid Billing	Medicaid: State	Insert			FL	6/1/2012 7:39 AM
Medicaid Billing	NPI: Number	Insert			1265514764	6/1/2012 7:39 AM
Medicaid Billing	NPI: Number	Insert			1699874248	6/1/2012 7:39 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/1/2012 7:39 AM
Details	Last Recertification Date	Insert				9/14/2007 8:47 AM
Details	Grant Number	Insert				9/14/2007 8:47 AM
Details	340B ID	Insert			DSH100113A	9/14/2007 8:47 AM
Details	Is Authorizing Official EHB Data	Insert				9/14/2007 8:47 AM
Dates	Last Date That 340B Drugs Purchased	Insert				9/14/2007 8:47 AM
Details	Medicare Provider Number	Insert			100113	9/14/2007 8:47 AM
Details	Entity Name	Insert			SHANDS TEACHING HOSPITAL AND CLINICS, INC.	9/14/2007 8:47 AM
Details	Program Code	Insert			DSH	9/14/2007 8:47 AM
Details	Entity Subname	Insert			SHANDS CANCER CENTER, UNIVERSITY OF FLORIDA	9/14/2007 8:47 AM
Dates	Participating Approval Date	Insert			9/14/2007 8:47:15 AM	9/14/2007 8:47 AM
Details	State	Insert			Active	9/14/2007 8:47 AM
Dates	Registration Date	Insert			9/14/2007 12:00:00 AM	9/14/2007 8:47 AM
Dates	Signed By Date	Insert				9/14/2007 8:47 AM
Dates	Start Date	Insert			1/1/1995 12:00:00 AM	9/14/2007 8:47 AM
Terminations	Termination Comments	Insert				9/14/2007 8:47 AM
Terminations	Termination Date	Insert				9/14/2007 8:47 AM
Terminations	Termination Effective Date	Insert				9/14/2007 8:47 AM
Terminations	Termination Reason	Insert				9/14/2007 8:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	9/14/2007 8:29 AM
Medicaid Billing	Medicaid: Number	Insert			101528100	9/14/2007 8:29 AM
Medicaid Billing	Medicaid: State	Insert			FL	9/14/2007 8:29 AM