340B Drug Pricing Program Database
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DSH460009J University of Utah (Terminated)
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Main Details
Name
University of Utah
Subdivision Name
Stansbury Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460009J
Medicare Provider Number
460009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/26/2008
Participating Start Date
10/1/1999
Participating Approval Date
4/26/2008
Last Recertification Date
9/5/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
University of Utah Hospitals and Clinics
Charlton Gordon Park, Chief Financial Officer
(801) 585-1325
Primary Contact
University of Utah Health
Nathan Hagen, Primary Care and Community Pharmacy Director
(801) 213-8630
Addresses
Street Address
220 Millpond Rd
Stansbury Park, UT 84074-9760
Billing Address
University of Utah Hospital
Accounts Payable
PO Box 2790
Salt Lake City, UT 84110-2790
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/28/08 SUB-DIV NAME CHANGE (WAS STANSBURY CLINIC PHARMACY)
04/26/2008
April 2025
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