Covered Entity Details

DSH010033M UNIVERSITY OF ALABAMA HOSPITAL (Active) - information as of 5/6/2025 12:00:08 AM

Main Details

Name

UNIVERSITY OF ALABAMA HOSPITAL

Subdivision Name

Acton Road Cardiology/ Oncology Clinic - Cardiology/ Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH010033M

Medicare Provider Number

010033

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/13/2022

Participating Start Date

7/1/2022

Participating Approval Date

4/14/2022

Last Recertification Date

8/19/2024

Contacts

Authorizing Official

UAB Hospital
Susan Jennings, CFO, UAB Hospital
(205) 934-7659

Primary Contact

UAB Hospital
TOMIE ANN BOACKLE, Director, Informatics and Regulatory Affairs
(205) 975-9780

Addresses

Street Address

2145 Bonner Way
3rd Floor
Birmingham, AL 35243

Billing Address

The University of Alabama at Birmingham Attn: Accounts Payable
801 Financial Services Building
801 5th Avenue South
Birmingham, AL 35233

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
AL	HOS0033H	1154435824,1033217708,1235237900
GA	000101626A	1033217708,1154435824,1235237900
MS	00020395	1033217708,1154435824,1235237900
LA	1744760	1033217708,1154435824,1235237900

Shipping Addresses

Shipping Address 1

Acton Road Cardiology/ Oncology Clinic- Cardiology/ Oncology
2145 Bonner Way
3rd Floor
Birmingham, AL 35243

Shipping Address 2

UAB Hospital Infusion Pharmacy at Acton Road
2145 Bonner Way
Suite 101
Birmingham, AL 35243

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
DSH010033AA	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Radiology – CT Highlands - Radiology – CT Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033AB	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Recovery - Highlands - Recovery - Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033AC	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Respiratory Therapy – Highlands - Respiratory Therapy – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033AD	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Same Day Surgery – Highlands - Same Day Surgery – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033AE	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Sleep Center – Highlands - Sleep Center – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033AF	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UAB EMERGENCY DEPARTMENT - Emergency Department – Highlands	1201 11TH AVENUE SOUTH	BIRMINGHAM	AL	Active
DSH010033AG	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Radiology - Ultrasound Highlands - Radiology - Ultrasound Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033AH	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Radiology - MRI Highlands - Radiology - MRI Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033AJ	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Radiology - Diagnostic Highlands - Radiology - Diagnostic Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033AK	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Acton Road Radiation Oncology Clinic - Rad/ Onc Clinic Acton	2145 Bonner Way	Birmingham	AL	Active
DSH010033AL	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UAB MEDICINE AT MEDICAL WEST - UAB Cardiology Med West	5000 MEDICAL WEST WAY	BESSEMER	AL	Approved
DSH010033AM	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UAB MEDICINE AT MEDICAL WEST - UAB Rheumatology Med West	5000 MEDICAL WEST WAY	BESSEMER	AL	Approved
DSH010033AN	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UAB MEDICINE AT MEDICAL WEST - UAB Neurosurgery Med West	5000 MEDICAL WEST WAY	BESSEMER	AL	Approved
DSH010033AP	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UAB MEDICINE AT MEDICAL WEST - UAB Pulmonary Med West	5000 MEDICAL WEST WAY	BESSEMER	AL	Approved
DSH010033AQ	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UAB MEDICINE AT MEDICAL WEST - UAB Pulmonary Function Test Med West	5000 MEDICAL WEST WAY	BESSEMER	AL	Approved
DSH010033AR	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UAB MEDICINE AT MEDICAL WEST - UAB Physical Med & Rehab Med West	5000 MEDICAL WEST WAY	BESSEMER	AL	Approved
DSH010033G	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UNIVERSITY OF ALABAMA INFUSION CENTER AT ACTON ROAD	2145 BONNER WAY	BIRMINGHAM	AL	Active
DSH010033J	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	UAB MEDICINE EMERGENCY - Gardendale Free Standing Emergency (Gardendale FED)	960 MOUNT OLIVE RD	GARDENDALE	AL	Active
DSH010033K	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Acton Road Hematology/ Oncology Clinic - Hem Onc Clinic Acton	2145 Bonner Way	Birmingham	AL	Active
DSH010033L	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Acton Road Breast Health Clinic - Breast Health Clinic	2145 Bonner Way	Birmingham	AL	Active
DSH010033M	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Acton Road Cardiology/ Oncology Clinic - Cardiology/ Oncology	2145 Bonner Way	Birmingham	AL	Active
DSH010033N	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Acton Road GI Surgery Clinic - Gastroenterology Surgery Clinic	2145 Bonner Way	Birmingham	AL	Active
DSH010033P	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Acton Road Urology Clinic - Urology Clinic	2145 Bonner Way	Birmingham	AL	Active
DSH010033Q	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	ANESTHESIA SERVICES AT UAB HOSPITAL - Anesthesia - Highlands	1201 11TH AVENUE SOUTH	BIRMINGHAM	AL	Active
DSH010033R	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Blood Bank – Highlands - Blood Bank – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033S	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Cardiology/ Radiology – Highlands - Cardiology/ Radiology – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033T	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Endoscopy - Highlands - Endoscopy - Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033U	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Lab – Highlands - Lab – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033V	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Nuclear Medicine – Highlands - Nuclear Medicine – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033W	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Occupational Therapy – Highlands - Occupational Therapy – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033X	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	OR – Highlands - OR – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033Y	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Pain Clinic – Highlands - Pain Clinic – Highlands	1201 11th Avenue South	Birmingham	AL	Active
DSH010033Z	Child	DSH	UNIVERSITY OF ALABAMA HOSPITAL	Physical Therapy – Highlands - Physical Therapy – Highlands	1201 11th Avenue South	Birmingham	AL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Insert	Group Change Request		The University of Alabama at Birmingham Attn: Accounts Payable 801 Financial Services Building 801 5th Avenue South Birmingham, AL 35233	9/27/2024 12:57 PM
Details	Last Recertification Date	Update	Recertification	8/21/2023 6:28:28 PM	8/19/2024 8:51:10 AM	8/19/2024 8:51 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 2:12:10 PM	8/21/2023 6:28:28 PM	8/21/2023 6:28 PM
Addresses	Shipping Address	Insert	Recertification		Acton Road Cardiology/ Oncology Clinic- Cardiology/ Oncology 2145 Bonner Way 3rd Floor Birmingham, AL 35243	8/31/2022 2:12 PM
Addresses	Shipping Address	Insert	Recertification		UAB Hospital Infusion Pharmacy at Acton Road 2145 Bonner Way Suite 101 Birmingham, AL 35243	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000101626A	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		GA	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		00020395	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MS	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1744760	8/31/2022 2:12 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		LA	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033217708	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1235237900	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		AL	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033217708	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1154435824	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1235237900	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033217708	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1154435824	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1235237900	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		MS	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1033217708	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1154435824	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/31/2022 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1235237900	8/31/2022 2:12 PM
Medicaid Billing	NPI: State	Insert	Recertification		LA	8/31/2022 2:12 PM
Details	Last Recertification Date	Update	Recertification		8/31/2022 2:12:10 PM	8/31/2022 2:12 PM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Jennings, Susan CFO, UAB Hospital UAB Hospital 2059347659	4/14/2022 10:42 AM
Details	340B ID	Update	New Registration		DSH010033M	4/14/2022 10:42 AM
Details	Entity Subname	Update	New Registration	Acton Road Cardiology/ Oncology Clinic	Acton Road Cardiology/ Oncology Clinic - Cardiology/ Oncology	4/14/2022 10:42 AM
Dates	Participating Approval Date	Update	New Registration		4/14/2022 10:42:35 AM	4/14/2022 10:42 AM
Details	State	Update	New Registration	Pending	Approved	4/14/2022 10:42 AM
Dates	Signed By Date	Update	New Registration		4/13/2022 6:11:44 PM	4/14/2022 10:42 AM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	4/14/2022 10:42 AM
Addresses	Main Address	Insert	New Registration		2145 Bonner Way 3rd Floor Birmingham, AL 35243	4/13/2022 5:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/13/2022 5:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		HOS0033H	4/13/2022 5:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		AL	4/13/2022 5:35 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1154435824	4/13/2022 5:35 PM
Medicaid Billing	NPI: State	Insert	New Registration		AL	4/13/2022 5:35 PM
Contacts	Primary Contact	Insert	New Registration		BOACKLE, TOMIE ANN Director, Informatics and Regulatory Affairs UAB Hospital 2059759780	4/13/2022 5:35 PM
Contacts	Authorizing Official	Insert	New Registration		Jennings, Susan CFO, UAB Hospital UAB Hospital 2059347659	4/13/2022 5:35 PM
Details	Assistance Received From Date	Insert	New Registration			4/13/2022 5:35 PM
Details	Assistance Received To Date	Insert	New Registration			4/13/2022 5:35 PM
Details	Last Recertification Date	Insert	New Registration			4/13/2022 5:35 PM
Details	Grant Number	Insert	New Registration			4/13/2022 5:35 PM
Details	340B ID	Insert	New Registration			4/13/2022 5:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2022 5:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2022 5:35 PM
Details	Medicare Provider Number	Insert	New Registration		010033	4/13/2022 5:35 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF ALABAMA HOSPITAL	4/13/2022 5:35 PM
Details	NOFO Number	Insert	New Registration			4/13/2022 5:35 PM
Details	Program Code	Insert	New Registration		DSH	4/13/2022 5:35 PM
Details	Entity Subname	Insert	New Registration		Acton Road Cardiology/ Oncology Clinic	4/13/2022 5:35 PM
Dates	Participating Approval Date	Insert	New Registration			4/13/2022 5:35 PM
Details	State	Insert	New Registration		Pending	4/13/2022 5:35 PM
Dates	Registration Date	Insert	New Registration		4/13/2022 5:35:36 PM	4/13/2022 5:35 PM
Dates	Signed By Date	Insert	New Registration			4/13/2022 5:35 PM
Dates	Start Date	Insert	New Registration			4/13/2022 5:35 PM
Terminations	Termination Comments	Insert	New Registration			4/13/2022 5:35 PM
Terminations	Termination Date	Insert	New Registration			4/13/2022 5:35 PM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2022 5:35 PM
Terminations	Termination Reason	Insert	New Registration			4/13/2022 5:35 PM