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DSH170040A UNIVERSITY OF KANSAS HOSPITAL (Active)
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Main Details
Name
UNIVERSITY OF KANSAS HOSPITAL
Subdivision Name
CC-CLINIC EXAM
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170040A
Medicare Provider Number
170040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
9/7/2007
Participating Start Date
10/1/2000
Participating Approval Date
9/7/2007
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
University of Kansas Health System
Rick Couldry, Vice-President, Pharmacy and Clinical Professions
(913) 588-2301
Primary Contact
University of Kansas Health System
Monica Marie Lubeck, VP Financial Operations
(913) 588-6632
Addresses
Street Address
2650 Shawnee Mission Pkwy.
Level 1-2
Westwood, KS 66205-2003
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/28/08- CORRECTED MEDICAID # (ADDED 010567808-MO; REMOVED 100103330A-KS); 12/8/04 - NEW MED# (WAS 6086212101); 5/8/06 - NEW MED # (WAS 100319330B-KS AND 600567804-MO); 9/6/07- NAME AND ADDR MOD (WAS CANCER CENTER, 3901 RAINBOW BLVD., KANSAS CITY, KS 66160), CHANGED 1 OF 2 MEDICAID NUMBERS - WAS 010567808 (MO)
05/28/2008
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