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DSH440015 UNIVERSITY OF TENNESSEE MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF TENNESSEE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440015
Medicare Provider Number
440015
Additional Details
Current Program Status
Active
Registration Date
4/29/2008
Participating Start Date
7/1/2001
Participating Approval Date
4/29/2008
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
1924 ALCOA HWY
KNOXVILLE, TN 37920
Billing Address
UNIVERSITY OF TENNESSEE MEDICAL CENTER
PHARMACY
1924 ALCOA HWY
KNOXVILLE, TN 37920
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/2/12 ADDED NPI#; 3/24/09 ADDED BILLING AND SHIPPING ADDRESSES
04/03/2012
3/24/09 ADDED BILLING AND SHIPPING ADDRESSES
03/24/2009
April 2025
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