340B Drug Pricing Program Database


DSH290007K UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA (Active) - information as of 5/11/2025 11:37:34 PM

Main Details
UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA
QUICK CARE: PECCOLE
Disproportionate Share Hospital
No
DSH290007K
290007
290007


Additional Details
Active
7/12/2013
10/1/2013
9/12/2013
8/26/2024

Contacts

University Medical Center of Southern Nevada
Mason Van Houweling, CEO
(702) 383-3862

University Medical Center of Southern Nevada
Jamie King, Director, Pharmaceutical Services
(702) 383-3791

Addresses

9320 W. Sahara Ave.
Las Vegas, NV 89117

University Medical Center of Southern Nevada
1800 W. Charleston Blvd.
Las Vegas, NV 89102


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NV1548393127,1760517635,1891820775,1942335823,1881727360,1609900521,1710549829,1891357901,1568024669,1376105478,1982662912,1649832759,1467014571,1992367007,1538721642,1002877,12028771376105478,1467014571,1538721642,1548393127,1568024669,1609900521,1649832759,1710549829,1760517635,1881727360,1891357901,1891820775,1942335823,1982662912,1992367007
AZ209171376105478,1467014571,1538721642,1548393127,1568024669,1609900521,1649832759,1710549829,1760517635,1881727360,1891357901,1891820775,1942335823,1982662912,1992367007
CA15483931271376105478,1467014571,1538721642,1548393127,1568024669,1609900521,1649832759,1710549829,1760517635,1881727360,1891357901,1891820775,1942335823,1982662912,1992367007
UT15483931271376105478,1467014571,1538721642,1548393127,1568024669,1609900521,1649832759,1710549829,1760517635,1881727360,1891357901,1891820775,1942335823,1982662912,1992367007
ID15483931271376105478,1467014571,1538721642,1548393127,1568024669,1609900521,1649832759,1710549829,1760517635,1881727360,1891357901,1891820775,1942335823,1982662912,1992367007
OR366241376105478,1467014571,1538721642,1548393127,1568024669,1609900521,1649832759,1710549829,1760517635,1881727360,1891357901,1891820775,1942335823,1982662912,1992367007
Shipping Addresses

University Medical Center of Southern Nevada
1800 W. Charleston Blvd.
Las Vegas, NV 89102

Safecor
4060 Business Park Dr.
Suite B
Columbus, OH 43204
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH290007AAChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAPRIMARY CARE: SPRING VALLEY4180 S Rainbow Blvd.Las VegasNVActive
DSH290007ABChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAPRIMARY CARE: SUNSET525 Marks StreetHendersonNVActive
DSH290007ACChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAPRIMARY CARE: SOUTHERN HIGHLANDS11860 Southern Highlands ParkwayLas VegasNVActive
DSH290007ADChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAEMERGENCY: PEDIATRICS800 Hope Place, 3rd floorLas VegasNVActive
DSH290007AEChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADATRAUMA CENTER800 Hope Place, 1st floorLas VegasNVActive
DSH290007AFChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADACLINIC:PEDIATRICS OUTPATIENT800 Hope Place, 3rd floorLas VegasNVActive
DSH290007AGChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: CENTENNIAL5785 Centennial Center Blvd.LAS VEGASNVActive
DSH290007AHChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAPRIMARY CARE: CENTENNIAL5785 Centennial Center Blvd.Las VegasNVActive
DSH290007AJChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: BLUE DIAMOND4760 Blue Diamond Rd.LAS VEGASNVActive
DSH290007AKChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAUNIVERSITY MEDICAL CENTER - EXPRESS CARE5757 WAYNE NEWTON BLVDLAS VEGASNVActive
DSH290007ALChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAUMC WELLNESS CENTER - PEDIATRIC INFECTIOUS DISEASE HOD CLINIC701 SHADOW LNLAS VEGASNVActive
DSH290007AMChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAUMC WELLNESS CENTER - PRIMARY CARE: WELLNESS701 SHADOW LNLAS VEGASNVActive
DSH290007ANChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAWELLNESS CENTER - INFECTIOUS DISEASE OUTPATIENT701 SHADOW LANELAS VEGASNVActive
DSH290007APChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAOrthopedic Clinic - Orthopedics2231 W. Charleston Blvd.Las VegasNVActive
DSH290007AQChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAAliante Primary Care - Primary Care5860 Losee RoadNorth Las VegasNVActive
DSH290007ARChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAOP Infusion Clinic - Outpatient Infusions701 Shadow LaneLas VegasNVActive
DSH290007ASChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAAliante Quick Care - Quick Care5860 Losee RoadNorth Las VegasNVActive
DSH290007ATChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAPC @ The Medical District - Primary Care1524 Pinto LaneLas VegasNVApproved
DSH290007AUChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAOrtho Clinic @ Rancho - Orthopedics4231 N. Rancho Dr.Las VegasNVApproved
DSH290007KChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: PECCOLE9320 W. Sahara Ave.Las VegasNVActive
DSH290007LChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: ENTERPRISE1700 Wheeler Peak Dr.Las VegasNVActive
DSH290007MChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: SUNSET525 Marks St.HendersonNVActive
DSH290007NChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADACLINIC: POST TRANSPLANT901 Rancho LaneLas VegasNVActive
DSH290007PChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADACLINIC: HIV WELLNESS CENTER701 Shadow LaneLas VegasNVActive
DSH290007SChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: SUMMERLIN2031 N. Buffalo Dr.Las VegasNVActive
DSH290007TChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: SPRING VALLEY4180 S. Rainbow Blvd.Las VegasNVActive
DSH290007UChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: RANCHO/CRAIG4231 N. Rancho Dr.Las VegasNVActive
DSH290007VChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAQUICK CARE: NELLIS61 N. Nellis Blvd.Las VegasNVActive
DSH290007WChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAPRIMARY CARE: NELLIS63 N Nellis Blvd.Las VegasNVActive
DSH290007XChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAPRIMARY CARE: PECCOLE9320 W Sahara Ave.Las VegasNVActive
DSH290007YChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAPRIMARY CARE: SUMMERLIN2031 N Buffalo DriveLas VegasNVActive
DSH290007ZChildDSHUNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADAUMC PRIMARY CARE - RANCHO/CRAIG4233 N RANCHO DRIVELAS VEGASNVTerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification9/11/2023 4:32:47 PM8/26/2024 2:06:16 PM8/26/2024 2:06 PM
DetailsLast Recertification DateUpdateRecertification9/13/2022 7:24:01 PM9/11/2023 4:32:47 PM9/11/2023 4:32 PM
DetailsLast Recertification DateUpdateRecertification9/13/2021 2:26:48 PM9/13/2022 7:24:01 PM9/13/2022 7:24 PM
AddressesShipping AddressInsertRecertification Safecor 4060 Business Park Dr. Suite B Columbus, OH 432049/13/2021 2:26 PM
DetailsLast Recertification DateUpdateRecertification9/14/2020 2:19:50 PM9/13/2021 2:26:48 PM9/13/2021 2:26 PM
Medicaid BillingNPI: NumberDeleteRecertification1710549829 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1891357901 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1568024669 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1376105478 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1982662912 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1649832759 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1467014571 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1992367007 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1538721642 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1548393127 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1760517635 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1891820775 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1942335823 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 13761054789/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 14670145719/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15387216429/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15483931279/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15680246699/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16099005219/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16498327599/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17105498299/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17605176359/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18817273609/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18913579019/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18918207759/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19423358239/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19826629129/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19923670079/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification NV9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 13761054789/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 14670145719/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15387216429/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15483931279/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15680246699/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16099005219/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16498327599/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17105498299/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17605176359/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18817273609/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18913579019/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18918207759/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19423358239/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19826629129/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19923670079/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification CA9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 13761054789/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 14670145719/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15387216429/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15483931279/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15680246699/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16099005219/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16498327599/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17105498299/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17605176359/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18817273609/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18913579019/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18918207759/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19423358239/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19826629129/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19923670079/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification UT9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 13761054789/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 14670145719/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15387216429/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15483931279/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15680246699/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16099005219/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16498327599/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17105498299/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17605176359/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18817273609/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18913579019/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18918207759/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19423358239/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19826629129/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19923670079/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification ID9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 13761054789/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 14670145719/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15387216429/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15483931279/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15680246699/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16099005219/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16498327599/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17105498299/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17605176359/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18817273609/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18913579019/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18918207759/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19423358239/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19826629129/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19923670079/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification AZ9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 13761054789/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 14670145719/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15387216429/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15483931279/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 15680246699/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16099005219/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 16498327599/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17105498299/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 17605176359/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18817273609/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18913579019/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 18918207759/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19423358239/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19826629129/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberInsertRecertification 19923670079/14/2020 2:19 PM
Medicaid BillingNPI: StateInsertRecertification OR9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1881727360 ( ) 9/14/2020 2:19 PM
Medicaid BillingNPI: NumberDeleteRecertification1609900521 ( ) 9/14/2020 2:19 PM
DetailsLast Recertification DateUpdateRecertification9/16/2019 1:38:11 PM9/14/2020 2:19:50 PM9/14/2020 2:19 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
Medicaid BillingMedicaid: NumberInsertChange Request 15483931271/15/2020 1:33 PM
Medicaid BillingMedicaid: StateInsertChange Request NV1/15/2020 1:33 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
Medicaid BillingMedicaid: NumberInsertChange Request 17605176351/15/2020 1:33 PM
Medicaid BillingMedicaid: StateInsertChange Request NV1/15/2020 1:33 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
Medicaid BillingMedicaid: NumberInsertChange Request 18918207751/15/2020 1:33 PM
Medicaid BillingMedicaid: StateInsertChange Request NV1/15/2020 1:33 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
Medicaid BillingMedicaid: NumberInsertChange Request 19423358231/15/2020 1:33 PM
Medicaid BillingMedicaid: StateInsertChange Request NV1/15/2020 1:33 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
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Medicaid BillingMedicaid: StateInsertChange Request NV1/15/2020 1:33 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
Medicaid BillingMedicaid: NumberInsertChange Request 16099005211/15/2020 1:33 PM
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Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
Medicaid BillingMedicaid: NumberInsertChange Request 17105498291/15/2020 1:33 PM
Medicaid BillingMedicaid: StateInsertChange Request NV1/15/2020 1:33 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
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Medicaid BillingMedicaid: StateInsertChange Request NV1/15/2020 1:33 PM
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Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
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Medicaid BillingMedicaid: Is PrimaryInsertChange Request False1/15/2020 1:33 PM
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Medicaid BillingNPI: NumberInsertChange Request 17105498291/15/2020 1:33 PM
Medicaid BillingNPI: NumberInsertChange Request 18913579011/15/2020 1:33 PM
Medicaid BillingNPI: NumberInsertChange Request 15680246691/15/2020 1:33 PM
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Medicaid BillingNPI: NumberInsertChange Request 19923670071/15/2020 1:33 PM
Medicaid BillingNPI: NumberInsertChange Request 15387216421/15/2020 1:33 PM
DetailsLast Recertification DateUpdateRecertification9/10/2018 5:36:48 PM9/16/2019 1:38:11 PM9/16/2019 1:38 PM
DetailsEntity SubnameUpdateRecertificationUMC Quick Care - PeccoleQUICK CARE: PECCOLE9/16/2019 1:38 PM
DetailsLast Recertification DateUpdateRecertification12/5/2017 6:37:12 PM9/10/2018 5:36:48 PM9/10/2018 5:36 PM
DetailsLast Recertification DateUpdateRecertification8/17/2016 12:00:00 AM12/5/2017 6:37:12 PM12/5/2017 6:37 PM
ContactsAuthorizing OfficialUpdateChange RequestVan Houweling, Mason CEO 7023833862Van Houweling, Mason CEO University Medical Center of Southern Nevada 702383386211/2/2017 4:32 PM
ContactsPrimary ContactUpdate King, Jamie Director, Pharmaceutical Services 7023833791King, Jamie Director, Pharmaceutical Services University Medical Center of Southern Nevada 702383379110/12/2017 4:48 PM
ContactsAuthorizing OfficialInsert  Van Houweling, Mason CEO 70238338627/17/2017 4:26 PM
ContactsPrimary ContactUpdate Nazifi, Meddie Director, Pharmaceutical Services 7023837841King, Jamie Director, Pharmaceutical Services 70238337915/8/2017 7:32 AM
ContactsSigned ByInsert  Brannman, Brian CEO 70238338624/14/2017 10:17 AM
AddressesMain AddressInsert   9320 W. Sahara Ave. Las Vegas, NV 891174/14/2017 10:16 AM
AddressesBilling AddressInsert  University Medical Center of Southern Nevada 1800 W. Charleston Blvd. Las Vegas, NV 891024/14/2017 10:16 AM
AddressesShipping AddressInsert  University Medical Center of Southern Nevada 1800 W. Charleston Blvd. Las Vegas, NV 891024/14/2017 10:16 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/14/2017 10:15 AM
Medicaid BillingMedicaid: NumberInsert  10028774/14/2017 10:15 AM
Medicaid BillingMedicaid: StateInsert  NV4/14/2017 10:15 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/14/2017 10:15 AM
Medicaid BillingMedicaid: NumberInsert  12028774/14/2017 10:15 AM
Medicaid BillingMedicaid: StateInsert  NV4/14/2017 10:15 AM
Medicaid BillingNPI: NumberInsert  18817273604/14/2017 10:15 AM
Medicaid BillingNPI: NumberInsert  16099005214/14/2017 10:15 AM
DetailsEntity SubnameUpdate Quick Care PeccoleUMC Quick Care - Peccole4/14/2017 10:15 AM
ContactsPrimary ContactInsert  Nazifi, Meddie Director, Pharmaceutical Services 70238378418/23/2016 8:16 AM
DetailsLast Recertification DateUpdate 8/7/2015 12:00:00 AM8/17/2016 12:00:00 AM8/22/2016 8:08 PM
DetailsLast Recertification DateUpdate 8/20/2014 12:00:00 AM8/7/2015 12:00:00 AM8/7/2015 7:30 AM
DetailsLast Recertification DateUpdate  8/20/2014 12:00:00 AM8/20/2014 2:02 PM
DatesParticipating Approval DateUpdate  9/12/2013 12:00:00 AM9/12/2013 11:44 AM
DetailsStateUpdate PendingActive9/12/2013 11:44 AM
DatesStart DateUpdate  10/1/2013 12:00:00 AM9/12/2013 11:44 AM
Medicaid BillingNPI: NumberInsert  15483931278/16/2013 11:02 AM
Medicaid BillingNPI: NumberInsert  17605176358/16/2013 11:02 AM
Medicaid BillingNPI: NumberInsert  18918207758/16/2013 11:02 AM
Medicaid BillingNPI: NumberInsert  19423358238/16/2013 11:02 AM
Details340B IDUpdate OUTPATIENT_ONLINE_REGDSH290007K8/16/2013 11:02 AM
DetailsLast Recertification DateInsert   7/12/2013 3:43 PM
DetailsGrant NumberInsert   7/12/2013 3:43 PM
Details340B IDInsert  OUTPATIENT_ONLINE_REG7/12/2013 3:43 PM
DetailsIs Authorizing Official EHB DataInsert   7/12/2013 3:43 PM
DatesLast Date That 340B Drugs PurchasedInsert   7/12/2013 3:43 PM
DetailsMedicare Provider NumberInsert  2900077/12/2013 3:43 PM
DetailsEntity NameInsert  UNIVERSITY MEDICAL CENTER OF SOUTHERN NEVADA7/12/2013 3:43 PM
DetailsProgram CodeInsert  DSH7/12/2013 3:43 PM
DetailsEntity SubnameInsert  Quick Care Peccole7/12/2013 3:43 PM
DatesParticipating Approval DateInsert   7/12/2013 3:43 PM
DetailsStateInsert  Pending7/12/2013 3:43 PM
DatesRegistration DateInsert  7/12/2013 12:00:00 AM7/12/2013 3:43 PM
DatesSigned By DateInsert  7/12/2013 12:00:00 AM7/12/2013 3:43 PM
DatesStart DateInsert   7/12/2013 3:43 PM
TerminationsTermination CommentsInsert   7/12/2013 3:43 PM
TerminationsTermination DateInsert   7/12/2013 3:43 PM
TerminationsTermination Effective DateInsert   7/12/2013 3:43 PM
TerminationsTermination ReasonInsert   7/12/2013 3:43 PM