Covered Entity Details

DSH180067M UNIVERSITY OF KENTUCKY (Active) - information as of 4/25/2025 12:01:48 AM

Main Details

Name

UNIVERSITY OF KENTUCKY

Subdivision Name

UK Good Samaritan Hospital Operating Room

Type

Disproportionate Share Hospital

Rural

340B ID

DSH180067M

Medicare Provider Number

180067

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/2/2012

Participating Start Date

1/1/2013

Participating Approval Date

11/27/2012

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

UK HealthCare
Timothy Andrew Slocum, Senior Vice President & Chief Operations Officer
(859) 257-4119

Primary Contact

University of Kentucky
Philip J Almeter, Chief Pharmacy Officer
(859) 323-1088

Addresses

Street Address

310 S. Limestone St
Lexington, KY 40508

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
KY	01013978	1073609731,1114305307,1174967269,1295190833,1326489071,1386057990,1518911338,1336728450,1275291759,1780342246
IN	100069710A	1073609731,1114305307,1174967269,1295190833,1326489071,1386057990,1518911338,1336728450,1275291759,1780342246
OH	0023085	1073609731,1114305307,1174967269,1295190833,1326489071,1386057990,1518911338,1336728450,1275291759,1780342246
TN	9180092	1073609731,1114305307,1174967269,1295190833,1326489071,1386057990,1518911338,1336728450,1275291759,1780342246
VA	9811109	1073609731,1114305307,1174967269,1295190833,1326489071,1386057990,1518911338,1336728450,1275291759,1780342246
WV	0174042000	1073609731,1114305307,1174967269,1295190833,1326489071,1386057990,1518911338,1336728450,1275291759,1780342246

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
DSH180067AA	Child	DSH	UNIVERSITY OF KENTUCKY	University of Kentucky Hospital Kentucky Neuroscience Institute	Kentucky Clinic, First floor, Wing C	Lexington	KY	Active
DSH180067AB	Child	DSH	UNIVERSITY OF KENTUCKY	Kentucky Children's Hospital Hematology Oncology Clinic	Kentucky Children's Hospital, UK Chandler Hospital - Pavilion HA, 4th Floor	Lexington	KY	Active
DSH180067AC	Child	DSH	UNIVERSITY OF KENTUCKY	University of Kentucky Hospital Transplant & Specialty Clinic	3 Audobon Plaza Dr	Louisville	KY	Active
DSH180067AD	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Interventional Pain Associates	2400 Greatstone Point	Lexington	KY	Active
DSH180067AE	Child	DSH	UNIVERSITY OF KENTUCKY	University of Kentucky Hospital Orthopedic Surgery, Physical and Occupational Therapy	Kentucky Clinic, Wing C, Room D135	Lexington	KY	Active
DSH180067AF	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Good Samaritan Cardiopulmonary Rehabilitation	135 E. Maxwell Street	Lexington	KY	Active
DSH180067AG	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Good Samaritan Sleep Disorders Center	310 S. Limestone	Lexington	KY	Active
DSH180067AH	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Good Samaritan Echo Service / University of Kentucky Echo Services	125 E. Maxwell Street	Lexington	KY	Active
DSH180067AJ	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Good Samaritan OB-GYN Ultrasound Services / UK Obstetrics & Gynecology Ultrasound	125 E. Maxwell Street	Lexington	KY	Active
DSH180067AK	Child	DSH	UNIVERSITY HOSPITAL	UK APPALACHIAN HEART CENTER	90 BALL PARK RD	HARLAN	KY	Terminated
DSH180067AL	Child	DSH	UNIVERSITY HOSPITAL	UK APPALACHIAN HEART CENTER	200 MEDICAL CENTER DR 2A	HAZARD	KY	Terminated
DSH180067AM	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC POLK DALTON CLINIC	217 ELM TREE LN	LEXINGTON	KY	Active
DSH180067AN	Child	DSH	UNIVERSITY OF KENTUCKY	UK Transplant Clinic	Kentucky Clinic, Third Floor, Wing D, Room J301	Lexington	KY	Active
DSH180067AP	Child	DSH	UNIVERSITY OF KENTUCKY	NICU Graduate Clinic	740 South Limestone	Lexington	KY	Terminated
DSH180067AQ	Child	DSH	UNIVERSITY OF KENTUCKY	UK Infusion Center	800 Rose Street	Lexington	KY	Active
DSH180067AR	Child	DSH	UNIVERSITY OF KENTUCKY	PEDIATRIC SPECIALTY	SECOND FLOOR, WING D	LEXINGTON	KY	Active
DSH180067AS	Child	DSH	UNIVERSITY OF KENTUCKY	Ben F. Roach Cancer Center Facility - Multidisciplinary Clinic - Head, Neck and Respiratory Clinic	800 Rose St - 2nd Floor	Lexington	KY	Active
DSH180067AT	Child	DSH	UNIVERSITY OF KENTUCKY	MARKEY CANCER CENTER @ LEX CLINIC - Markey Lexington Clinic - Oncology	2195 Harrodsburg Rd	LEXINGTON	KY	Active
DSH180067AU	Child	DSH	UNIVERSITY OF KENTUCKY	UK HEALTHCARE MEDICINE SPECIALTIES - Medicine Specialties	740 S LIMESTONE	LEXINGTON	KY	Active
DSH180067AV	Child	DSH	UNIVERSITY OF KENTUCKY	Physical Medicine & Rehabilitation Clinic - Orthopedic Clinic Ambulatory	2050 Versailles Rd	Lexington	KY	Active
DSH180067AW	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Physical Therapy - Physical Therapy	125 E. Maxwell St.	Lexington	KY	Active
DSH180067AX	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC NEPHROLOGY - UKHC NEPHROLOGY	135 E MAXWELL ST	LEXINGTON	KY	Active
DSH180067AY	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC CARDIOVASCULAR AND THORACIC SU - UKHC CARDIOVASCULAR AND THORACIC SURGERY	740 S LIMESTONE	LEXINGTON	KY	Active
DSH180067AZ	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC PSYCHIATRIC AND BEH HEALTH CAR - UKHC PSYCHIATRIC AND BEHAVIORAL HEALTH CARE	245 FOUNTAIN CT	LEXINGTON	KY	Active
DSH180067B	Child	DSH	UNIVERSITY OF KENTUCKY	UK GOOD SAMARITAN HOSPITAL	310 S. LIMESTONE STREET	LEXINGTON	KY	Active
DSH180067BA	Child	DSH	UNIVERSITY OF KENTUCKY	POLK DALTON FAMILY CARE CENTER - UKHC Pediatrics - Family Care Center	1135 HARRY SYKES WAY	LEXINGTON	KY	ToBeTerminated
DSH180067BB	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC WOMEN'S HEALTH - UKHC WOMEN'S HEALTH	740 S LIMESTONE	LEXINGTON	KY	Active
DSH180067BC	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC INTERNAL MEDICINE - UKHC INTERNAL MEDICINE	830 S LIMESTONE	LEXINGTON	KY	Active
DSH180067BD	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC BARNSTABLE BROWN DIABETES CENT - Barnstable Brown Diabetes Center - Adult, Peds and Education Ctr	2195 HARRODSBURG RD	LEXINGTON	KY	Active
DSH180067BE	Child	DSH	UNIVERSITY OF KENTUCKY	GILL HEART AND VASCULAR INSTITUTE @ - GILL HEART AND VASCULAR INSTITUTE @ MAXWELL	125 E MAXWELL ST	LEXINGTON	KY	Active
DSH180067BF	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC GYNECOLOGIC ONCOLOGY - UKHC GYNECOLOGIC ONCOLOGY	800 ROSE ST	LEXINGTON	KY	Active
DSH180067BG	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC FAMILY & COMMUNITY MEDICINE - UKHC FAMILY & COMMUNITY MEDICINE	2195 HARRODSBURG RD	LEXINGTON	KY	Active
DSH180067BH	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC UNIVERSITY HEALTH SERVICES - UKHC UNIVERSITY HEALTH SERVICES	830 S LIMESTONE	LEXINGTON	KY	Active
DSH180067BJ	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC Speech Language Pathology - UKHC Speech Language Pathology	135 E. Maxwell St.	Lexington	KY	Active
DSH180067BK	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC HAND THERAPY - Hand Therapy	2195 HARRODSBURG RD	LEXINGTON	KY	Active
DSH180067BL	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC HAND CENTER - Hand Surgery Clinic	2195 HARRODSBURG RD	LEXINGTON	KY	Active
DSH180067BM	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC KNI CHILD NEUROLOGY - Child Neuro Clinic	2195 HARRODSBURG RD	LEXINGTON	KY	Active
DSH180067BN	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC GENERAL SURGERY - UKHC General Surgery Clinic	740 SOUTH LIMESTONE	LEXINGTON	KY	Active
DSH180067BP	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC UROLOGY - UKHC Urology Clinic	740 SOUTH LIMESTONE	LEXINGTON	KY	Active
DSH180067BQ	Child	DSH	UNIVERSITY OF KENTUCKY	UKH SPECIALTY CARE CLINIC @ MAXWELL - SPECIALTY CARE CLINIC @ MAXWELL	135 EAST MAXWELL ST	LEXINGTON	KY	Active
DSH180067BR	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC GENERAL PEDIATRICS - Pediatrics	2400 GREATSTONE PT	LEXINGTON	KY	Active
DSH180067BS	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC DISCHARGE CLINIC - UKHC DISCHARGE CLINIC	2195 HARRODSBURG RD	LEXINGTON	KY	Active
DSH180067BT	Child	DSH	UNIVERSITY OF KENTUCKY	VASCULAR & INTERVENTIONAL RADIOLOGY - UKHC VASCULAR & INTERVENTIONAL RADIOLOGY	740 S. LIMESTONE	LEXINGTON	KY	Active
DSH180067BU	Child	DSH	UNIVERSITY OF KENTUCKY	UK Urgent Care Turfland - UK Urgent Care Turfland	2195 Harrodsburg Rd	Lexington	KY	Active
DSH180067BV	Child	DSH	UNIVERSITY OF KENTUCKY	Georgetown Family & Community Medicine - Georgetown Family & Community Medicine	202 Bevins Lane	Georgetown	KY	Active
DSH180067BW	Child	DSH	UNIVERSITY OF KENTUCKY	GS MOB Urology - GS MOB Urology	125 East Maxwell St.	Lexington	KY	Active
DSH180067BX	Child	DSH	UNIVERSITY OF KENTUCKY	Turfland Plastic and Reconstructive Surgery - Turfland Plastic and Reconstructive Surgery	2195 Harrodsburg Rd	Lexington	KY	Active
DSH180067BY	Child	DSH	UNIVERSITY OF KENTUCKY	UK Fountain Court Primary and Urgent Care Clinic - UK Fountain Court Primary and Urgent Care Clinic	245 Fountain Court	Lexington	KY	Active
DSH180067BZ	Child	DSH	UNIVERSITY OF KENTUCKY	GS MOB Surgery - GS MOB Surgery	125 East Maxwell St.	Lexington	KY	Active
DSH180067C	Child	DSH	UNIVERSITY OF KENTUCKY	Marylou Whitney and John Hendrickson Cancer Facility for Women - Outpatient Infusion Suite	800 Rose St	Lexington	KY	Active
DSH180067CA	Child	DSH	UNIVERSITY OF KENTUCKY	Team Blue Primary Care - Team Blue Primary Care	2400 Greatstone Point	Lexington	KY	Active
DSH180067CB	Child	DSH	UNIVERSITY OF KENTUCKY	Turfland General and Weight Loss Surgery Clinic - Turfland General and Weight Loss Surgery Clinic	2195 Harrodsburg Rd	Lexington	KY	Active
DSH180067CC	Child	DSH	UNIVERSITY OF KENTUCKY	PEDIATRIC DIAGNOSTIC & INFUSION CLI - PEDIATRIC DIAGNOSTIC & INFUSION CLI	740 S LIMESTONE	LEXINGTON	KY	Active
DSH180067CD	Child	DSH	UNIVERSITY OF KENTUCKY	MARKEY CANCER CNTR AT LEX CL RICHMO - MARKEY CANCER CNTR AT LEX CL RICHMO	2019 CORPORATE DR	RICHMOND	KY	Active
DSH180067CE	Child	DSH	UNIVERSITY OF KENTUCKY	KENTUCKY CHILDREN'S RICHMOND ROAD - KENTUCKY CHILDREN'S RICHMOND ROAD	1900 RICHMOND RD	LEXINGTON	KY	Active
DSH180067CF	Child	DSH	UNIVERSITY OF KENTUCKY	BONE MINERAL AND METABOLISM - BONE MINERAL AND METABOLISM	135 E MAXWELL ST	LEXINGTON	KY	Active
DSH180067CG	Child	DSH	UNIVERSITY OF KENTUCKY	Cancer Acute Treatment Clinic at Markey Cancer Center - Cancer Acute Treatment Clinic at Markey Cancer Center	800 Rose Street, 2nd Floor	Lexington	KY	Active
DSH180067CH	Child	DSH	UNIVERSITY OF KENTUCKY	UKHC COMPREHENSIVE VASCULAR CLINIC - UKHC COMPREHENSIVE VASCULAR CLINIC	740 S LIMESTONE	LEXINGTON	KY	Active
DSH180067D	Child	DSH	UNIVERSITY OF KENTUCKY	Marylou Whitney and John Hendrickson Cancer Facility for Women - Breast Care Center	232 Whitney Hendrickson Building	Lexington	KY	Active
DSH180067E	Child	DSH	UNIVERSITY OF KENTUCKY	Marylou Whitney and John Hendrickson Cancer Facility for Women - Multidisciplinary Clinic	800 Rose St	Lexington	KY	Active
DSH180067F	Child	DSH	UNIVERSITY OF KENTUCKY	Ben F. Roach Cancer Center Facility - Markey Hematologic Clinic	750 Rose St	Lexington	KY	Active
DSH180067G	Child	DSH	UNIVERSITY OF KENTUCKY	Ben F. Roach Cancer Center Facility - Radiation Medicine Clinic	750 Rose St	Lexington	KY	Active
DSH180067H	Child	DSH	UNIVERSITY OF KENTUCKY	Ben F. Roach Cancer Center Facility - UK Gamma Knife Center	750 Rose St	Lexington	KY	Active
DSH180067J	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Endoscopy	310 S. Limestone St	Lexington	KY	Active
DSH180067K	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Pre-Op	310 S. Limestone St	Lexington	KY	ToBeTerminated
DSH180067L	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Post-Op	310 S. Limestone St	Lexington	KY	Active
DSH180067M	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Operating Room	310 S. Limestone St	Lexington	KY	Active
DSH180067N	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Emergency Room	310 S. Limestone St	Lexington	KY	Active
DSH180067P	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Computed Tomography	310 S. Limestone St	Lexington	KY	Active
DSH180067Q	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Interventional Radiology	135 E Maxwell St, Suite 301	Lexington	KY	ToBeTerminated
DSH180067R	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Nuclear Medicine	310 S. Limestone St	Lexington	KY	Active
DSH180067S	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Sports Physical Therapy	2195 Harrodsburg Rd.	Lexington	KY	Active
DSH180067T	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Kentucky Neurosciences Institute Clinic - Electroencephalography	Kentucky Clinic, First floor, Wing C	Lexington	KY	Active
DSH180067U	Child	DSH	UNIVERSITY OF KENTUCKY	UK Good Samaritan Hospital Radiology	310 S. Limestone St	Lexington	KY	Active
DSH180067V	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Good Samaritan Diagnostic Center	135 E. Maxwell Street	Lexington	KY	Active
DSH180067W	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Good Samaritan Wound Care Center	135 E. Maxwell Street	Lexington	KY	Terminated
DSH180067X	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Pre-Op Clinic	Kentucky Clinic, First Floor, Wing D, Room J111	Lexington	KY	Active
DSH180067Y	Child	DSH	UNIVERSITY OF KENTUCKY	UK HealthCare Pediatric Cardiology	Kentucky Clinic, Second Floor, Wing D	Lexington	KY	Active
DSH180067Z	Child	DSH	UNIVERSITY OF KENTUCKY	University of Kentucky Hospital Kentucky Clinic Radiology	Kentucky Clinic, First floor, Wing C	Lexington	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Swartz, Colleen Hope Vice President for Hospital Operations University of Kentucky HealthCare 8593614496	Slocum, Timothy Andrew Senior Vice President & Chief Operations Officer UK HealthCare 8592574119	2/9/2025 12:22 PM
Details	Last Recertification Date	Update	Recertification	8/31/2023 2:51:05 PM	8/15/2024 11:03:08 AM	8/15/2024 11:03 AM
Details	Last Recertification Date	Update	Recertification	8/30/2022 4:09:01 PM	8/31/2023 2:51:05 PM	8/31/2023 2:51 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275291759	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780342246	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275291759	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780342246	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275291759	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780342246	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275291759	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780342246	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275291759	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780342246	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275291759	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	8/30/2022 4:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1780342246	8/30/2022 4:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	8/30/2022 4:09 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 10:48:46 AM	8/30/2022 4:09:01 PM	8/30/2022 4:09 PM
Contacts	Authorizing Official	Update	Profile Change Request	Swartz, Colleen Hope Chief Nurse Executive/Chief Administrative Officer University of Kentucky HealthCare 8593614496	Swartz, Colleen Hope Vice President for Hospital Operations University of Kentucky HealthCare 8593614496	8/29/2022 1:25 PM
Contacts	Primary Contact	Update	Profile Change Request	Almeter, Philip J Enterprise Director, Pharmacy Services University of Kentucky 8593231088	Almeter, Philip J Chief Pharmacy Officer University of Kentucky 8593231088	8/29/2022 10:32 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1336728450	9/17/2021 12:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		OH	9/17/2021 12:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336728450	9/17/2021 12:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		KY	9/17/2021 12:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336728450	9/17/2021 12:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		WV	9/17/2021 12:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336728450	9/17/2021 12:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		IN	9/17/2021 12:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336728450	9/17/2021 12:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		TN	9/17/2021 12:46 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1336728450	9/17/2021 12:46 PM
Medicaid Billing	NPI: State	Insert	Change Request		VA	9/17/2021 12:46 PM
Contacts	Primary Contact	Update	Recertification	Fields, Philip Director, Inpatient Pharmacy Operations University of Kentucky 8593233724	Almeter, Philip J Enterprise Director, Pharmacy Services University of Kentucky 8593231088	8/30/2021 10:48 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 1:06:54 PM	8/30/2021 10:48:46 AM	8/30/2021 10:48 AM
Medicaid Billing	Medicaid: Number	Update	Recertification	100069710A	100069710A	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073609731	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114305307	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174967269	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295190833	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326489071	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386057990	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518911338	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		OH	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073609731	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114305307	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174967269	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295190833	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326489071	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386057990	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518911338	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073609731	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114305307	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174967269	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295190833	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326489071	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386057990	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518911338	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		WV	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073609731	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114305307	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174967269	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295190833	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326489071	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386057990	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518911338	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073609731	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114305307	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174967269	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295190833	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326489071	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386057990	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518911338	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1073609731	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114305307	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174967269	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295190833	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1326489071	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1386057990	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1518911338	9/3/2020 1:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		VA	9/3/2020 1:06 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1518911338 ( )		9/3/2020 1:06 PM
Details	Last Recertification Date	Update	Recertification	9/9/2019 10:35:34 AM	9/3/2020 1:06:54 PM	9/3/2020 1:06 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 1:26:09 PM	9/9/2019 10:35:34 AM	9/9/2019 10:35 AM
Contacts	Authorizing Official	Update	AO Change Request	Cofield, Robert VP & Chief Clinical Operations Officer University of Kentucky 8592574368	Swartz, Colleen Hope Chief Nurse Executive/Chief Administrative Officer University of Kentucky HealthCare 8593614496	11/14/2018 1:47 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 10:16:02 AM	8/20/2018 1:26:09 PM	8/20/2018 1:26 PM
Contacts	Primary Contact	Insert	Recertification		Fields, Philip Director, Inpatient Pharmacy Operations University of Kentucky 8593233724	11/10/2017 10:16 AM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/10/2017 10:16:02 AM	11/10/2017 10:16 AM
Contacts	Authorizing Official	Update		Cofield, Robert VP & Chief Clinical Operations Officer 8592574368	Cofield, Robert VP & Chief Clinical Operations Officer University of Kentucky 8592574368	10/15/2017 7:53 PM
Contacts	Authorizing Official	Insert			Cofield, Robert VP & Chief Clinical Operations Officer 8592574368	7/3/2017 11:11 AM
Contacts	Signed By	Insert			Smith, Ann CHIEF ADMINISTRATIVE OFFICER 8593235470	6/14/2017 11:27 AM
Addresses	Main Address	Insert			310 S. Limestone St Lexington, KY 40508	6/14/2017 11:25 AM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 9:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Number	Insert			100069710A	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: State	Insert			IN	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Number	Insert			0023085	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: State	Insert			OH	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Number	Insert			9180092	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: State	Insert			TN	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Number	Insert			9811109	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: State	Insert			VA	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: Number	Insert			0174042000	2/18/2016 2:47 PM
Medicaid Billing	Medicaid: State	Insert			WV	2/18/2016 2:47 PM
Medicaid Billing	NPI: Number	Insert			1518911338	2/18/2016 2:47 PM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 8:25 AM
Details	Last Recertification Date	Update		8/19/2013 8:50:45 AM	8/6/2014 12:00:00 AM	8/6/2014 9:11 AM
Details	Last Recertification Date	Update			8/19/2013 8:50:45 AM	8/19/2013 8:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/15/2013 4:01 PM
Medicaid Billing	Medicaid: Number	Insert			01013978	1/15/2013 4:01 PM
Medicaid Billing	Medicaid: State	Insert			KY	1/15/2013 4:01 PM
Details	340B ID	Update		IS-DR-DSH180067M	DSH180067M	11/27/2012 5:48 PM
Dates	Participating Approval Date	Update			11/27/2012 12:00:00 AM	11/27/2012 5:48 PM
Details	State	Update		Pending	Active	11/27/2012 5:48 PM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	11/27/2012 5:48 PM
Details	Entity Subname	Update		UK Good Samaritan Hospital Operating Room - 5th Floor	UK Good Samaritan Hospital Operating Room	11/19/2012 1:54 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-DR-DSH180067M	11/16/2012 3:27 PM
Details	Last Recertification Date	Insert				10/2/2012 10:12 AM
Details	Grant Number	Insert				10/2/2012 10:12 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	10/2/2012 10:12 AM
Details	Is Authorizing Official EHB Data	Insert				10/2/2012 10:12 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/2/2012 10:12 AM
Details	Medicare Provider Number	Insert			180067	10/2/2012 10:12 AM
Details	Entity Name	Insert			UNIVERSITY OF KENTUCKY	10/2/2012 10:12 AM
Details	Program Code	Insert			DSH	10/2/2012 10:12 AM
Details	Entity Subname	Insert			UK Good Samaritan Hospital Operating Room - 5th Floor	10/2/2012 10:12 AM
Dates	Participating Approval Date	Insert				10/2/2012 10:12 AM
Details	State	Insert			Pending	10/2/2012 10:12 AM
Dates	Registration Date	Insert			10/2/2012 12:00:00 AM	10/2/2012 10:12 AM
Dates	Signed By Date	Insert			10/2/2012 12:00:00 AM	10/2/2012 10:12 AM
Dates	Start Date	Insert				10/2/2012 10:12 AM
Terminations	Termination Comments	Insert				10/2/2012 10:12 AM
Terminations	Termination Date	Insert				10/2/2012 10:12 AM
Terminations	Termination Effective Date	Insert				10/2/2012 10:12 AM
Terminations	Termination Reason	Insert				10/2/2012 10:12 AM