Covered Entity Details

DSH440048AU BAPTIST MEM HOSPITAL MEMPHIS (Active) - information as of 5/20/2025 12:51:05 AM

Main Details

Name

BAPTIST MEM HOSPITAL MEMPHIS

Subdivision Name

BMH - COLLIERVILLE / PACU

Type

Disproportionate Share Hospital

Rural

340B ID

DSH440048AU

Medicare Provider Number

440048

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/17/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/28/2017

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

Baptist Memorial Health Care Corporation
Cyndi Pittman, VP Financial Operations
(901) 227-8480

Primary Contact

Baptist Memorial Health Care Corp
Donna C Cox, Director 340B
(901) 227-5144

Addresses

Street Address

1500W POPLAR AVE
COLLIERVILLE, TN 38017-0601

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
TN	0440048	1578527172
MS	00020374	1578527172

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
DSH440048A	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH DIAGNOSTIC MRI	6286 BRIARCREST AVE	MEMPHIS	TN	Active
DSH440048AA	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	WOMENS HEALTH CENTER / Comprehensive Breast Ctr	50 HUMPHREYS BLVD	MEMPHIS	TN	Active
DSH440048AB	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	WOMENS HEALTH CENTER / Mammography	50 HUMPHREYS BLVD	MEMPHIS	TN	Active
DSH440048AC	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memphis Diagnostic Cardiac Lab	6029 Walnut Grove Drive, STE 201	Memphis	TN	Active
DSH440048AD	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Emergency Room	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AE	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / GI Lab	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AF	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Hemodialysis	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AG	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Neuro-Audio,ENG & IND	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AH	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Neuro Sleep Disorder	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AJ	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Electroneurodiagnostics	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AK	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / EKG Lab	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AL	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Respiratory Therapy	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AM	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Blood Bank	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AN	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Pathology	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AP	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Echo Lab	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AQ	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Rad-MRI	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AR	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Rad-CT	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AS	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Nuc Med	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AT	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Anesthesiology	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AU	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / PACU	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AV	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Surgery Services	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AW	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Ambulatory Clinic	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048AX	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH-COLLIERVILLE / DAC Physical Therapy	440W POWELL RD	COLLIERVILLE	TN	Active
DSH440048AY	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memphis Plaza Diagnostic Pavilion	6029 Walnut Grove Road, Suite C002	Memphis	TN	Terminated
DSH440048AZ	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital/PD's Perch Diagnostic	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048B	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	GI LAB #2	80 HUMPHREYS CENTER DRIVE	MEMPHIS	TN	Active
DSH440048BA	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH COLLIERVILLE / Ultrasound	1500 W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048BB	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH COLLIERVILLE / Mammography	1500 W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048BC	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH COLLIERVILLE / Speech Therapy	1500 W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048BD	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH COLLIERVILLE / Occupational Therapy	1500 W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048BE	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Physical Therapy	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048BF	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	BMH - COLLIERVILLE / Radiology Diagnostic	1500W POPLAR AVE	COLLIERVILLE	TN	Active
DSH440048BG	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Radiation Therapy Center	55 Humphreys Blvd, Suite 100	Memphis	TN	Active
DSH440048BH	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Advanced Disease Center	6025 Walnut Grove, Suite 111	Memphis	TN	Active
DSH440048BJ	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Transplant Services	6025 Walnut Grove, Suite 111	Memphis	TN	Active
DSH440048BK	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memorial Hospital-Memphis Arlington Rad Ultrasound - Rad Ultrasound	5150 Airline Rd	Arlington	TN	Active
DSH440048BL	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memorial Hospital- Memphis- Arlington Emergency Department - Free Standing ER	5150 Airline Rd	Arlington	TN	Active
DSH440048BM	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memorial Hospital Memphis- Arlington Rad Diagnostic - Rad Diagnostic	5150 Airline Rd	Arlington	TN	Active
DSH440048BN	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memorial Hospital-Memphis Arlington MRI - MRI	5150 Arline Rd	Arlington	TN	Active
DSH440048BP	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memorial Hospital-Memphis Arlington CT - CT	5150 Airline Rd	Arlington	TN	Active
DSH440048C	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memphis Stern / Ultra Sound	8060 Wolf River Blvd	Germantown	TN	Active
DSH440048D	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memphis Stern / Nuc Med	8060 Wolf River Blvd	Germantown	TN	Active
DSH440048E	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memphis Stern / Pacemaker	8060 Wolf River Blvd	Germantown	TN	Active
DSH440048F	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Memphis-Stern / Echo	8060 Wolf River Blvd	Germantown	TN	Active
DSH440048G	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	THE CENTER FOR URINARY AND PELVIC DISORDERS	6215 HUMPHREYS BLVD	MEMPHIS	TN	Active
DSH440048H	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital/Emergency Room	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048J	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital/Neuro-Audio,ENG & IND	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048K	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital/Electroneurodiagnostics	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048L	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital/Physical Therapy	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048M	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital/Respiratory Therapy	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048N	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Blood Bank	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048P	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Pathology Lab	6225 Humphreys Blvd	Memphis	TN	Terminated
DSH440048Q	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Echo Lab	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048R	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Rad-MRI	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048S	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Rad-CT	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048T	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Rad-Ultrasound	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048U	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Rad-Diagnostic	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048V	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Anesthesiology	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048W	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Labor and Delivery	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048X	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / PACU	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048Y	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	Baptist Women's Hospital / Surgery	6225 Humphreys Blvd	Memphis	TN	Active
DSH440048Z	Child	DSH	BAPTIST MEM HOSPITAL MEMPHIS	WOMENS HEALTH CENTER / UltraSound	50 HUMPHREYS BLVD	MEMPHIS	TN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 3:16:33 PM	8/26/2024 5:58:11 PM	8/26/2024 5:58 PM
Contacts	Authorizing Official	Update	AO Change Request	Young, Kimberly Vice President-Finance Operations Baptist Memorial Health Care Corporation 9012274080	Pittman, Cyndi VP Financial Operations Baptist Memorial Health Care Corporation 9012278480	11/15/2023 3:22 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 3:27:56 PM	8/22/2023 3:16:33 PM	8/22/2023 3:16 PM
Medicaid Billing	NPI: Number	Delete	Group Change Request	1578527172 (AR)		6/29/2023 2:28 PM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	107093105 (AR)		6/14/2023 3:11 PM
Details	Last Recertification Date	Update	Recertification	8/18/2021 3:47:23 PM	8/30/2022 3:27:56 PM	8/30/2022 3:27 PM
Details	Last Recertification Date	Update	Recertification	9/3/2020 4:02:10 PM	8/18/2021 3:47:23 PM	8/18/2021 3:47 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578527172	9/3/2020 4:02 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	9/3/2020 4:02 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578527172	9/3/2020 4:02 PM
Medicaid Billing	NPI: State	Insert	Recertification		TN	9/3/2020 4:02 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578527172	9/3/2020 4:02 PM
Medicaid Billing	NPI: State	Insert	Recertification		AR	9/3/2020 4:02 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1578527172 ( )		9/3/2020 4:02 PM
Details	Last Recertification Date	Update	Recertification	9/11/2019 4:27:53 PM	9/3/2020 4:02:10 PM	9/3/2020 4:02 PM
Contacts	Primary Contact	Update	Profile Change Request	Cox, Donna C 340B Program Manager Baptist Memorial Health Care Corp 9012275144	Cox, Donna C Director 340B Baptist Memorial Health Care Corp 9012275144	1/16/2020 10:47 AM
Contacts	Authorizing Official	Update	Change Request	Barham, David VP, Operations Finance CFO Baptist Memorial Health Care Corp 9012277467	Young, Kimberly Vice President-Finance Operations Baptist Memorial Health Care Corporation 9012274080	12/16/2019 6:57 PM
Details	Last Recertification Date	Update	Recertification	9/5/2018 3:08:03 PM	9/11/2019 4:27:53 PM	9/11/2019 4:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/13/2018 2:40 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		107093105	12/13/2018 2:40 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AR	12/13/2018 2:40 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 3:53:04 PM	9/5/2018 3:08:03 PM	9/5/2018 3:08 PM
Details	Last Recertification Date	Update	Recertification		11/29/2017 3:53:04 PM	11/29/2017 3:53 PM
Contacts	Authorizing Official	Update	Change Request	Barham, David VP, Operations Finance CFO 9012277467	Barham, David VP, Operations Finance CFO Baptist Memorial Health Care Corp 9012277467	10/9/2017 5:10 PM
Contacts	Signed By	Update	Change Request	Barham, David VP, Operations Finance CFO 9012277467	Barham, David VP, Operations Finance CFO Baptist Memorial Health Care Corp 9012277467	10/9/2017 5:10 PM
Contacts	Primary Contact	Update		Cox, Donna 340B Program Manager 9012275144	Cox, Donna C 340B Program Manager Baptist Memorial Health Care Corp 9012275144	9/29/2017 11:10 AM
Contacts	Authorizing Official	Insert			Barham, David VP, Operations Finance CFO 9012277467	7/31/2017 6:31 PM
Contacts	Signed By	Insert			Barham, David VP, Operations Finance CFO 9012277467	7/31/2017 6:31 PM
Contacts	Primary Contact	Insert			Cox, Donna 340B Program Manager 9012275144	7/31/2017 6:31 PM
Addresses	Main Address	Insert			1500W POPLAR AVE COLLIERVILLE, TN 38017-0601	7/31/2017 6:31 PM
Medicaid Billing	NPI: Number	Insert			1578527172	6/15/2017 10:39 AM
Dates	Participating Approval Date	Update			4/28/2017 12:00:00 AM	4/28/2017 1:33 PM
Details	State	Update		Pending	Active	4/28/2017 1:33 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/28/2017 1:33 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_77386	DSH440048AU	4/25/2017 11:09 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_77386	4/17/2017 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/17/2017 4:43 PM
Medicaid Billing	Medicaid: Number	Insert			0440048	4/17/2017 4:43 PM
Medicaid Billing	Medicaid: State	Insert			TN	4/17/2017 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/17/2017 4:43 PM
Medicaid Billing	Medicaid: Number	Insert			00020374	4/17/2017 4:43 PM
Medicaid Billing	Medicaid: State	Insert			MS	4/17/2017 4:43 PM
Details	Last Recertification Date	Insert				4/17/2017 4:43 PM
Details	Grant Number	Insert				4/17/2017 4:43 PM
Details	340B ID	Insert				4/17/2017 4:43 PM
Details	Is Authorizing Official EHB Data	Insert				4/17/2017 4:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/17/2017 4:43 PM
Details	Medicare Provider Number	Insert			440048	4/17/2017 4:43 PM
Details	Entity Name	Insert			BAPTIST MEM HOSPITAL MEMPHIS	4/17/2017 4:43 PM
Details	Program Code	Insert			DSH	4/17/2017 4:43 PM
Details	Entity Subname	Insert			BMH - COLLIERVILLE / PACU	4/17/2017 4:43 PM
Dates	Participating Approval Date	Insert				4/17/2017 4:43 PM
Details	State	Insert			Pending	4/17/2017 4:43 PM
Dates	Registration Date	Insert			4/17/2017 12:00:00 AM	4/17/2017 4:43 PM
Dates	Signed By Date	Insert			4/17/2017 12:00:00 AM	4/17/2017 4:43 PM
Dates	Start Date	Insert				4/17/2017 4:43 PM
Terminations	Termination Comments	Insert				4/17/2017 4:43 PM
Terminations	Termination Date	Insert				4/17/2017 4:43 PM
Terminations	Termination Effective Date	Insert				4/17/2017 4:43 PM
Terminations	Termination Reason	Insert				4/17/2017 4:43 PM