Covered Entity Details

DSH180141N UNIVERSITY OF LOUISVILLE HOSPITAL (Active) - information as of 4/28/2025 11:25:49 PM

Main Details

Name

UNIVERSITY OF LOUISVILLE HOSPITAL

Subdivision Name

Bone Marrow Transplant Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH180141N

Medicare Provider Number

180141

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/10/2015

Participating Start Date

10/1/2015

Participating Approval Date

8/14/2015

Last Recertification Date

8/31/2024

Contacts

Authorizing Official

University of Louisville Hospital
Steve Amsler, Senior Vice President of Operations
(502) 562-4122

Primary Contact

UofL Health
Robert Michael Fink, System Vice President, Pharmacy Services
(502) 562-3211

Addresses

Street Address

550 South Jackson Street
ACB 3rd Floor
Louisville, KY 40202

Billing Address

University of Louisville Hospital
530 South Jackson Street
Louisville, KY 40202

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
IN	200074320A	1861554438
KY	01022433	1861554438

Shipping Addresses

Shipping Address 1

University of Louisville Hospital
550 South Jackson Street
ACB 1st Floor
Louisville, KY 40202

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
DSH180141A	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	BROWN CANCER CENTER	529 SOUTH JACKSON STREET	LOUISVILLE	KY	Terminated
DSH180141AA	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	BCC Bluegrass Infusion - Infusion	1460 Bluegrass Ave	Louisville	KY	Active
DSH180141AB	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	BCC MCNE Rad Onc - Radiology Oncology	2401 Terra Crossing Blvd	Louisville	KY	Active
DSH180141AC	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Multi-Specialty Clinic - Respitory Therapy	401 E. Chestnut Street	Louisville	KY	Active
DSH180141AD	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Advanced Bariatrics & Medical Weight Loss Clinic - Bariatrics	401 E. Chestnut Street	Louisville	KY	Active
DSH180141AE	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	UofL Health - University Hospital Infusion Center at Shelbyville Hospital - Infusion	727 Hospital Drive	Shelbyville	KY	Active
DSH180141AF	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	BCC MCNE BCT Clinic - Bone Marrow Celluar Transplant	2401 Terra Crossing Blvd	Louisville	KY	Active
DSH180141AG	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	ULH MTM Clinic - Medication Therapy Management	550 South Jackson Street	Louisville	KY	Active
DSH180141AH	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	BCC Bluegrass Clinic - Medical Oncology	1460 Bluegrass Avenue	Louisville	KY	Active
DSH180141AJ	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	BCC Infusion Services - Infusion	529 South Jackson Street	Louisville	KY	Active
DSH180141B	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	OUTPATIENT SERVICES	530 SOUTH JACKSON STREET	LOUISVILLE	KY	Terminated
DSH180141C	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	HEALTH CARE OUTPATIENT CENTER	401 EAST CHESTNUT STREET, SUITE 180	LOUISVILLE	KY	Terminated
DSH180141D	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	UNIVERSITY MEDICAL CENTER, INC. / Outpatient Surgery Center	401 E Chestnut	LOUISVILLE	KY	Active
DSH180141E	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Cyberknife	529 South Jackson Street	Louisville	KY	Active
DSH180141F	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Medical Oncology	529 South Jackson Street	Louisville	KY	Active
DSH180141G	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Radiation Oncology	529 South Jackson Street	Louisville	KY	Active
DSH180141H	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Infusion Services	529 South Jackson Street	Louisville	KY	Active
DSH180141J	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Bone Marrow Transplant Clinic	529 South Jackson Street	Louisville	KY	Terminated
DSH180141K	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	UNIVERSITY MEDICAL CENTER, INC. / Pain Management Clinic	530 S. JACKSON STREET	LOUISVILLE	KY	Terminated
DSH180141L	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	UNIVERSITY MEDICAL CENTER, INC. / Interventional Nephrology Center	530 S. JACKSON STREET	LOUISVILLE	KY	Terminated
DSH180141M	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Interventional Nephrology Center	401 East Chestnut Street	Louisville	KY	Active
DSH180141N	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Bone Marrow Transplant Clinic	550 South Jackson Street	Louisville	KY	Active
DSH180141P	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Pain Management Clinic	550 South Jackson Street	Louisville	KY	Active
DSH180141Q	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Infusion Clinic	401 East Chestnut Street	Louisville	KY	Active
DSH180141R	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	OC Radiology - Radiology	401 East Chestnut Street	Louisville	KY	Active
DSH180141S	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Specialty Clinic - GI Clinic	550 South Jackson Street	Louisville	KY	Terminated
DSH180141T	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Specialty Clinic - Hepatitis C Center	550 South Jackson Street	Louisville	KY	Active
DSH180141U	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Specialty Clinic - MS Center - MS Clinic	550 South Jackson Street	Louisville	KY	Active
DSH180141V	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	MCNE BCC Infusion - Infusion	2401 Terra Crossing Blvd	Louisville	KY	Active
DSH180141W	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	Breast Services - Breast Services	529 South Jackson Street	Louisville	KY	Active
DSH180141X	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	BCC Infusion 5E OP - Infusion	530 South Jackson Street	Louisville	KY	Active
DSH180141Y	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	PULMONARY CLINIC - Pulmonary Clinic	401 E CHESTNUT ST	LOUISVILLE	KY	Active
DSH180141Z	Child	DSH	UNIVERSITY OF LOUISVILLE HOSPITAL	BCC Bluegrass PET/ CT - Diagnostic	1460 Bluegrass Ave	Louisville	KY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/24/2023 2:41:26 PM	8/31/2024 10:11:01 PM	8/31/2024 10:11 PM
Contacts	Authorizing Official	Update	Profile Change Request	Amsler, Steve Vice President of Operations University of Louisville Hospital 5025624122	Amsler, Steve Senior Vice President of Operations University of Louisville Hospital 5025624122	7/12/2024 9:19 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 3:31:55 PM	8/24/2023 2:41:26 PM	8/24/2023 2:41 PM
Details	Last Recertification Date	Update	Recertification	9/3/2021 8:35:23 AM	8/26/2022 3:31:55 PM	8/26/2022 3:31 PM
Contacts	Primary Contact	Update	Profile Change Request	Fink, Robert Michael System Director, Pharmacy Services UofL Health 5022175095	Fink, Robert Michael System Vice President, Pharmacy Services UofL Health 5025623211	4/11/2022 3:09 PM
Details	Last Recertification Date	Update	Recertification	9/13/2020 11:49:11 PM	9/3/2021 8:35:23 AM	9/3/2021 8:35 AM
Addresses	Shipping Address	Delete	Change Request	University of Louisville Hospital 530 South Jackson Street Louisville, KY 40202		4/5/2021 10:19 AM
Addresses	Shipping Address	Delete	Change Request	University of Louisville Hospital 529 South Jackson Street Louisville, KY 40202		4/5/2021 10:19 AM
Addresses	Shipping Address	Delete	Change Request	University of Louisville Hospital 401 East Chestnut Street Suite 180 Louisville, KY 40202		4/5/2021 10:19 AM
Addresses	Shipping Address	Delete	Change Request	University of Louisville Hospital 550 South Jackson Street ACB 3rd Floor Louisville, KY 40202		4/5/2021 10:19 AM
Addresses	Shipping Address	Delete	Change Request	University of Louisville Hospital 550 South Jackson Street 1st Floor Pharmacy Louisville, KY 40202		4/5/2021 10:19 AM
Addresses	Shipping Address	Insert	Change Request		University of Louisville Hospital 550 South Jackson Street ACB 1st Floor Louisville, KY 40202	4/5/2021 10:19 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	200133200A (IN)		9/13/2020 11:49 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	5403796 (KY)		9/13/2020 11:49 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	50004241 (KY)		9/13/2020 11:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1861554438	9/13/2020 11:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		KY	9/13/2020 11:49 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1861554438	9/13/2020 11:49 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/13/2020 11:49 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1538266838 ( )		9/13/2020 11:49 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1861554438 ( )		9/13/2020 11:49 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1740449636 ( )		9/13/2020 11:49 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1093296717 ( )		9/13/2020 11:49 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 7:35:15 AM	9/13/2020 11:49:11 PM	9/13/2020 11:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/15/2020 10:26 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01022433	7/15/2020 10:26 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	7/15/2020 10:26 AM
Contacts	Primary Contact	Update	Change Request	Johnson, Jessica Leigh Manager, Outpatient Pharmacy Services University of Louisville Hospital 5025623571	Fink, Robert Michael System Director, Pharmacy Services UofL Health 5022175095	11/7/2019 9:23 AM
Details	Last Recertification Date	Update	Recertification	8/29/2018 1:45:24 PM	8/20/2019 7:35:15 AM	8/20/2019 7:35 AM
Addresses	Shipping Address	Insert	Change Request		University of Louisville Hospital 550 South Jackson Street ACB 3rd Floor Louisville, KY 40202	10/3/2018 10:20 AM
Addresses	Shipping Address	Insert	Change Request		University of Louisville Hospital 550 South Jackson Street 1st Floor Pharmacy Louisville, KY 40202	10/3/2018 10:20 AM
Addresses	Shipping Address	Insert	Change Request		University of Louisville Hospital 530 South Jackson Street Louisville, KY 40202	10/3/2018 10:20 AM
Addresses	Shipping Address	Insert	Change Request		University of Louisville Hospital 529 South Jackson Street Louisville, KY 40202	10/3/2018 10:20 AM
Addresses	Shipping Address	Insert	Change Request		University of Louisville Hospital 401 East Chestnut Street Suite 180 Louisville, KY 40202	10/3/2018 10:20 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/3/2018 10:20 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200133200A	10/3/2018 10:20 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	10/3/2018 10:20 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	10/3/2018 10:20 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200074320A	10/3/2018 10:20 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	10/3/2018 10:20 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1093296717	10/3/2018 10:20 AM
Details	Last Recertification Date	Update	Recertification	11/3/2017 4:01:56 PM	8/29/2018 1:45:24 PM	8/29/2018 1:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/11/2018 2:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		5403796	7/11/2018 2:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	7/11/2018 2:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/11/2018 2:53 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		50004241	7/11/2018 2:53 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	7/11/2018 2:53 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1538266838	7/11/2018 2:53 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1861554438	7/11/2018 2:53 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1740449636	7/11/2018 2:53 PM
Addresses	Main Address	Update	Change Request	529 South Jackson Street Brown Cancer Center 2nd Floor Louisville, KY 40202	550 South Jackson Street ACB 3rd Floor Louisville, KY 40202	1/23/2018 7:41 AM
Details	Last Recertification Date	Update	Recertification	8/17/2016 12:00:00 AM	11/3/2017 4:01:56 PM	11/3/2017 4:01 PM
Contacts	Primary Contact	Insert	Change Request		Johnson, Jessica Leigh Manager, Outpatient Pharmacy Services University of Louisville Hospital 5025623571	10/31/2017 1:58 PM
Contacts	Authorizing Official	Update		Amsler, Steve Vice President of Operations 5025624122	Amsler, Steve Vice President of Operations University of Louisville Hospital 5025624122	9/27/2017 2:10 PM
Contacts	Authorizing Official	Insert			Amsler, Steve Vice President of Operations 5025624122	7/14/2017 4:40 PM
Contacts	Signed By	Insert			Marshall, Ken President 5025626508	1/9/2017 4:40 PM
Addresses	Main Address	Insert			529 South Jackson Street Brown Cancer Center 2nd Floor Louisville, KY 40202	8/17/2016 3:10 PM
Details	Last Recertification Date	Update			8/17/2016 12:00:00 AM	8/17/2016 3:10 PM
Addresses	Billing Address	Insert			University of Louisville Hospital 530 South Jackson Street Louisville, KY 40202	8/5/2016 3:06 PM
Dates	Participating Approval Date	Update			8/14/2015 12:00:00 AM	8/14/2015 11:53 AM
Details	State	Update		Pending	Active	8/14/2015 11:53 AM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	8/14/2015 11:53 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_53090	DSH180141N	8/12/2015 4:00 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_53090	7/10/2015 3:21 PM
Details	Last Recertification Date	Insert				7/10/2015 3:21 PM
Details	Grant Number	Insert				7/10/2015 3:21 PM
Details	340B ID	Insert				7/10/2015 3:21 PM
Details	Is Authorizing Official EHB Data	Insert				7/10/2015 3:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/10/2015 3:21 PM
Details	Medicare Provider Number	Insert			180141	7/10/2015 3:21 PM
Details	Entity Name	Insert			UNIVERSITY OF LOUISVILLE HOSPITAL	7/10/2015 3:21 PM
Details	Program Code	Insert			DSH	7/10/2015 3:21 PM
Details	Entity Subname	Insert			Bone Marrow Transplant Clinic	7/10/2015 3:21 PM
Dates	Participating Approval Date	Insert				7/10/2015 3:21 PM
Details	State	Insert			Pending	7/10/2015 3:21 PM
Dates	Registration Date	Insert			7/10/2015 12:00:00 AM	7/10/2015 3:21 PM
Dates	Signed By Date	Insert			7/10/2015 12:00:00 AM	7/10/2015 3:21 PM
Dates	Start Date	Insert				7/10/2015 3:21 PM
Terminations	Termination Comments	Insert				7/10/2015 3:21 PM
Terminations	Termination Date	Insert				7/10/2015 3:21 PM
Terminations	Termination Effective Date	Insert				7/10/2015 3:21 PM
Terminations	Termination Reason	Insert				7/10/2015 3:21 PM