Covered Entity Details

DSH030006E TUCSON MEDICAL CENTER (Active) - information as of 5/29/2025 1:51:59 AM

Main Details

Name

TUCSON MEDICAL CENTER

Subdivision Name

Peppi's House

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH030006E

Medicare Provider Number

030006

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/9/2015

Participating Start Date

10/1/2015

Participating Approval Date

7/15/2015

Last Recertification Date

8/23/2024

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

2715 N Wyatt Drive
Tucson, AZ 85712

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
7/15/15 Cost center line is hospice	07/15/2015

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
AZ	020462	1174512792

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	Authorizing Official	Update	AO Change Request	Coomler, Maureen Chief Operating Officer Tucson Medical Center 5203244450	Reichling, Steve CFO TMCH 5203275461	3/24/2025 1:10 PM
Details	Last Recertification Date	Update	Recertification	8/24/2023 4:43:05 PM	8/23/2024 5:27:47 PM	8/23/2024 5:27 PM
Details	Last Recertification Date	Update	Recertification	9/2/2022 10:24:38 AM	8/24/2023 4:43:05 PM	8/24/2023 4:43 PM
Details	Last Recertification Date	Update	Recertification	8/27/2021 3:25:12 PM	9/2/2022 10:24:38 AM	9/2/2022 10:24 AM
Details	Last Recertification Date	Update	Recertification	8/31/2020 12:52:17 PM	8/27/2021 3:25:12 PM	8/27/2021 3:25 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1174512792	8/31/2020 12:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		AZ	8/31/2020 12:52 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1174512792 ( )		8/31/2020 12:52 PM
Details	Last Recertification Date	Update	Recertification	8/30/2019 2:33:15 PM	8/31/2020 12:52:17 PM	8/31/2020 12:52 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 4:59:47 PM	8/30/2019 2:33:15 PM	8/30/2019 2:33 PM
Contacts	Authorizing Official	Update	AO Change Request	Mlawsky, Karen COO Tucson Medical Center 5203243137	Coomler, Maureen Chief Operating Officer Tucson Medical Center 5203244450	8/20/2019 8:11 AM
Contacts	Primary Contact	Update	Recertification	Romero, Gilbert Director - Pharmacy Tucson Medical Center 5203243341	Koreny, Claudia Lorraine Director of Pharmacy Tucson Medical Center 5203242317	8/28/2018 4:59 PM
Details	Last Recertification Date	Update	Recertification	11/14/2017 11:58:48 AM	8/28/2018 4:59:47 PM	8/28/2018 4:59 PM
Contacts	Primary Contact	Update	Recertification	Hicks, Bret Director - Finance 5203241614	Romero, Gilbert Director - Pharmacy Tucson Medical Center 5203243341	11/14/2017 11:58 AM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/14/2017 11:58:48 AM	11/14/2017 11:58 AM
Contacts	Authorizing Official	Update		Mlawsky, Karen COO 5203243137	Mlawsky, Karen COO Tucson Medical Center 5203243137	10/5/2017 2:39 PM
Contacts	Signed By	Update		Mlawsky, Karen COO 5203243137	Mlawsky, Karen COO Tucson Medical Center 5203243137	10/5/2017 2:39 PM
Addresses	Main Address	Insert			2715 N Wyatt Drive Tucson, AZ 85712	7/12/2017 12:21 PM
Contacts	Authorizing Official	Insert			Mlawsky, Karen COO 5203243137	7/12/2017 12:21 PM
Contacts	Signed By	Insert			Mlawsky, Karen COO 5203243137	7/12/2017 12:21 PM
Contacts	Primary Contact	Insert			Hicks, Bret Director - Finance 5203241614	7/12/2017 12:21 PM
Medicaid Billing	NPI: Number	Update		1477542892	1174512792	8/11/2016 3:16 PM
Details	Last Recertification Date	Update			8/11/2016 12:00:00 AM	8/11/2016 3:16 PM
Dates	Participating Approval Date	Update			7/15/2015 12:00:00 AM	7/15/2015 6:01 PM
Details	State	Update		Pending	Active	7/15/2015 6:01 PM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	7/15/2015 6:01 PM
Details	Comments Public	Insert			7/15/15 Cost center line is hospice	7/15/2015 6:01 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_52813	DSH030006E	7/14/2015 10:11 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_52813	7/9/2015 12:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/9/2015 12:45 PM
Medicaid Billing	Medicaid: Number	Insert			020462	7/9/2015 12:45 PM
Medicaid Billing	Medicaid: State	Insert			AZ	7/9/2015 12:45 PM
Medicaid Billing	NPI: Number	Insert			1477542892	7/9/2015 12:45 PM
Details	Last Recertification Date	Insert				7/9/2015 12:45 PM
Details	Grant Number	Insert				7/9/2015 12:45 PM
Details	340B ID	Insert				7/9/2015 12:45 PM
Details	Is Authorizing Official EHB Data	Insert				7/9/2015 12:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/9/2015 12:45 PM
Details	Medicare Provider Number	Insert			030006	7/9/2015 12:45 PM
Details	Entity Name	Insert			TUCSON MEDICAL CENTER	7/9/2015 12:45 PM
Details	Program Code	Insert			DSH	7/9/2015 12:45 PM
Details	Entity Subname	Insert			Peppi's House	7/9/2015 12:45 PM
Dates	Participating Approval Date	Insert				7/9/2015 12:45 PM
Details	State	Insert			Pending	7/9/2015 12:45 PM
Dates	Registration Date	Insert			7/9/2015 12:00:00 AM	7/9/2015 12:45 PM
Dates	Signed By Date	Insert			7/9/2015 12:00:00 AM	7/9/2015 12:45 PM
Dates	Start Date	Insert				7/9/2015 12:45 PM
Terminations	Termination Comments	Insert				7/9/2015 12:45 PM
Terminations	Termination Date	Insert				7/9/2015 12:45 PM
Terminations	Termination Effective Date	Insert				7/9/2015 12:45 PM
Terminations	Termination Reason	Insert				7/9/2015 12:45 PM