Covered Entity Details

DSH440015X UNIVERSITY OF TENNESSEE MEDICAL CENTER (Active) - information as of 5/1/2025 11:55:03 PM

Main Details

Name

UNIVERSITY OF TENNESSEE MEDICAL CENTER

Subdivision Name

UNIV DIAGNOSTICS LENOIR CITY - Diagnostics

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH440015X

Medicare Provider Number

440015

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/6/2021

Participating Start Date

1/1/2022

Participating Approval Date

12/3/2021

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

University of Tennessee Medical Center
Kim C. Mason, Vice President, Pharmacy and Research
(865) 305-9124

Primary Contact

University of Tennessee Medical Center
Ivis Shane Trent, 340B Pharmacist
(865) 305-9166

Addresses

Street Address

5779 CREEKWOOD PARK BLVD
STE 130
LENOIR CITY, TN 37772-1203

Billing Address

University Health System, Inc
Accounts Payable
PO Box 32849
Knoxville, TN 37930-2849

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	0440015	1538164090
KY	01600055	1538164090

Shipping Addresses

Shipping Address 1

University Health System, Inc
dba UT Medical Center Pharmacy
1924 Alcoa Hwy
Knoxville, TN 37920

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
DSH440015A	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UNIVERSITY CANCER SPECIALISTS	1926 ALCOA HWY	KNOXVILLE	TN	Active
DSH440015AA	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UT INFUSION (COVID) - COVID	1928 ALCOA HWY	KNOXVILLE	TN	Terminated
DSH440015AB	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UNIV ONCOLOGY CLINIC TURKEY CREEK - Oncology	11440 PARKSIDE DR	KNOXVILLE	TN	Active
DSH440015AC	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	Cole Dystonia Clinic - Northshore- Botox	1975 Town Center BLVD	Knoxville	TN	Active
DSH440015AD	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UT PET/CT - Nuclear Medicine	1926 Alcoa Hwy, STE 140	Knoxville	TN	Active
DSH440015AE	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Medication Management Clinic - Med Mgmt	1928 Alcoa Hwy	Knoxville	TN	Active
DSH440015AF	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	Emergency Department - Jamestown	208 Central Avenue West	Jamestown	TN	Active
DSH440015AG	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Cancer Specialists - Halls	7326 Maynardville Pike	Knoxville	TN	Active
DSH440015AH	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Infusion Services- Morristown - UIS	6232 W. Andrew Johnson Highway	Talbott	TN	Active
DSH440015AJ	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Infusion Services- Halls - UIS	7326 Maynardville Pike	Knoxville	TN	Active
DSH440015B	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UNIVERSITY CANCER SPECIALISTS	1907 WEST MORRIS BLVD.	MORRISTOWN	TN	Terminated
DSH440015C	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Cancer Specialists	270 Joule Street	Alcoa	TN	Terminated
DSH440015D	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Cancer Specialists	5779 Creekwood Park Blvd. Suite 140	Lenoir City	TN	Active
DSH440015E	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Cancer Specialists	1130 Middle Creek Road	Sevierville	TN	Active
DSH440015F	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UNIVERSITY HEALTH SYSTEM INC	11440 PARKSIDE DRIVE	KNOXVILLE	TN	Active
DSH440015G	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Breast Center	1926 Alcoa Hwy, Ste 120	Knoxville	TN	Active
DSH440015H	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Radiation Oncology	1926 Alcoa Hwy, STE 130	Knoxville	TN	Active
DSH440015J	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UT Day Surgery	1934 Alcoa Hwy, STE 170	Knoxville	TN	Active
DSH440015K	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UT Wound Care and Enterostomal Therapy	1940 ALCOA HIGHWAY, STE E40	KNOXVILLE	TN	Active
DSH440015L	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	East Tennessee Comprehensive Hemophilia Center	11440 PARKSIDE DR	KNOXVILLE	TN	Active
DSH440015M	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	Cole Neuroscience Center	1928 ALCOA HWY., STE 102	KNOXVILLE	TN	Terminated
DSH440015N	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Infusion Services	1934 Alcoa Hwy, STE 478	Knoxville	TN	Active
DSH440015P	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Bariatric Center	1930 Alcoa Highway, A-240	Knoxville	TN	Terminated
DSH440015Q	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UTMC SLEEP DISORDER CLINIC	1928 ALCOA HWY	KNOXVILLE	TN	Active
DSH440015R	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	Cancer Services- Blount County	329 N. Hall Rd	Alcoa	TN	Active
DSH440015S	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UT Rheumatology	1932 Alcoa Highway	Knoxville	TN	Active
DSH440015T	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	University Oncology Clinic - oncology	1926 Alcoa Hwy, STE 200, 210 & 410	Knoxville	TN	Active
DSH440015U	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	Pulmonary Function Testing - UT Medical Center Pulmonary Function Testing	1940 Alcoa Highway	Knoxville	TN	Active
DSH440015V	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UNIVERSITY DIAGNOSTICS SEVIERVILLE - Diagnostics	1130 MIDDLE CREEK RD	SEVIERVILLE	TN	Active
DSH440015W	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UT NEUROLOGY - Neurology	1128 Weisgarber Rd, STE 230 & 250	KNOXVILLE	TN	Active
DSH440015X	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UNIV DIAGNOSTICS LENOIR CITY - Diagnostics	5779 CREEKWOOD PARK BLVD	LENOIR CITY	TN	Active
DSH440015Y	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UNIVERSITY DIAG AT NORTHSHORE - Diagnostics	1975 TOWN CENTER BLVD	KNOXVILLE	TN	Terminated
DSH440015Z	Child	DSH	UNIVERSITY OF TENNESSEE MEDICAL CENTER	UT GASTROENTEROLOGY - Gastroenterology	1930 Alcoa HWY	Knoxville	TN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/7/2023 2:38:09 PM	9/4/2024 3:12:39 PM	9/4/2024 3:12 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 11:40:22 AM	9/7/2023 2:38:09 PM	9/7/2023 2:38 PM
Contacts	Primary Contact	Update	Recertification	Mason, Kim C. Vice President, Pharmacy and Research University of Tennessee Medical Center 8653059124	Trent, Ivis Shane 340B Pharmacist University of Tennessee Medical Center 8653059166	9/14/2022 11:40 AM
Details	Last Recertification Date	Update	Recertification		9/14/2022 11:40:22 AM	9/14/2022 11:40 AM
Contacts	Authorizing Official	Update	Profile Change Request	Mason, Kim C. Executive Director of Pharmacy and Research University of Tennessee Medical Center 8653059124	Mason, Kim C. Vice President, Pharmacy and Research University of Tennessee Medical Center 8653059124	7/29/2022 7:21 AM
Contacts	Primary Contact	Update	Profile Change Request	Mason, Kim C. Executive Director of Pharmacy and Research University of Tennessee Medical Center 8653059124	Mason, Kim C. Vice President, Pharmacy and Research University of Tennessee Medical Center 8653059124	7/29/2022 7:21 AM
Contacts	Authorizing Official	Update	AO Change Request	Ross, Steven Robert Senior Vice President, Strategic Development University of Tennessee Medical Center 8653056400	Mason, Kim C. Executive Director of Pharmacy and Research University of Tennessee Medical Center 8653059124	7/28/2022 3:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1538164090	7/15/2022 9:31 AM
Medicaid Billing	NPI: State	Insert	Change Request		KY	7/15/2022 9:31 AM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Addresses	Billing Address	Insert	New Registration		University Health System, Inc Accounts Payable PO Box 32849 Knoxville, TN 37930-2849	12/3/2021 8:11 AM
Addresses	Shipping Address	Insert	New Registration		University Health System, Inc dba UT Medical Center Pharmacy 1924 Alcoa Hwy Knoxville, TN 37920	12/3/2021 8:11 AM
Contacts	Signed By	Insert	New Registration		Ross, Steven Robert Senior Vice President, Strategic Development University of Tennessee Medical Center 8653056400	12/3/2021 8:11 AM
Details	340B ID	Update	New Registration		DSH440015X	12/3/2021 8:11 AM
Details	Entity Name	Update	New Registration	UNIVERSITY OF TENNESSEE MEDICAL CENT	UNIVERSITY OF TENNESSEE MEDICAL CENTER	12/3/2021 8:11 AM
Details	Entity Subname	Update	New Registration	UNIV DIAGNOSTICS LENOIR CITY	UNIV DIAGNOSTICS LENOIR CITY - Diagnostics	12/3/2021 8:11 AM
Dates	Participating Approval Date	Update	New Registration		12/3/2021 8:11:32 AM	12/3/2021 8:11 AM
Details	State	Update	New Registration	Pending	Approved	12/3/2021 8:11 AM
Dates	Signed By Date	Update	New Registration		10/6/2021 1:50:05 PM	12/3/2021 8:11 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	12/3/2021 8:11 AM
Addresses	Main Address	Insert	New Registration		5779 CREEKWOOD PARK BLVD STE 130 LENOIR CITY, TN 37772-1203	10/6/2021 12:53 PM
Addresses	Billing Address	Insert	New Registration		University Health System, Inc Accounts Payable PO Box 32849 Knoxville, TN 37930-2849	10/6/2021 12:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/6/2021 12:53 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0440015	10/6/2021 12:53 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TN	10/6/2021 12:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/6/2021 12:53 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		01600055	10/6/2021 12:53 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		KY	10/6/2021 12:53 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538164090	10/6/2021 12:53 PM
Medicaid Billing	NPI: State	Insert	New Registration		TN	10/6/2021 12:53 PM
Contacts	Primary Contact	Insert	New Registration		Mason, Kim C. Executive Director of Pharmacy and Research University of Tennessee Medical Center 8653059124	10/6/2021 12:53 PM
Contacts	Authorizing Official	Insert	New Registration		Ross, Steven Robert Senior Vice President, Strategic Development University of Tennessee Medical Center 8653056400	10/6/2021 12:53 PM
Details	Assistance Received From Date	Insert	New Registration			10/6/2021 12:53 PM
Details	Assistance Received To Date	Insert	New Registration			10/6/2021 12:53 PM
Details	Last Recertification Date	Insert	New Registration			10/6/2021 12:53 PM
Details	Grant Number	Insert	New Registration			10/6/2021 12:53 PM
Details	340B ID	Insert	New Registration			10/6/2021 12:53 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/6/2021 12:53 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/6/2021 12:53 PM
Details	Medicare Provider Number	Insert	New Registration		440015	10/6/2021 12:53 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF TENNESSEE MEDICAL CENT	10/6/2021 12:53 PM
Details	NOFO Number	Insert	New Registration			10/6/2021 12:53 PM
Details	Program Code	Insert	New Registration		DSH	10/6/2021 12:53 PM
Details	Entity Subname	Insert	New Registration		UNIV DIAGNOSTICS LENOIR CITY	10/6/2021 12:53 PM
Dates	Participating Approval Date	Insert	New Registration			10/6/2021 12:53 PM
Details	State	Insert	New Registration		Pending	10/6/2021 12:53 PM
Dates	Registration Date	Insert	New Registration		10/6/2021 12:53:42 PM	10/6/2021 12:53 PM
Dates	Signed By Date	Insert	New Registration			10/6/2021 12:53 PM
Dates	Start Date	Insert	New Registration			10/6/2021 12:53 PM
Terminations	Termination Comments	Insert	New Registration			10/6/2021 12:53 PM
Terminations	Termination Date	Insert	New Registration			10/6/2021 12:53 PM
Terminations	Termination Effective Date	Insert	New Registration			10/6/2021 12:53 PM
Terminations	Termination Reason	Insert	New Registration			10/6/2021 12:53 PM