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DSH440015A UNIVERSITY OF TENNESSEE MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF TENNESSEE MEDICAL CENTER
Subdivision Name
UNIVERSITY CANCER SPECIALISTS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440015A
Medicare Provider Number
440015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/30/2010
Participating Start Date
10/1/2010
Participating Approval Date
8/5/2010
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
1926 ALCOA HWY
SUITE 400
KNOXVILLE, TN 37920
Billing Address
Pharmacy Finance
1924 Alcoa Hwy, U41
KNOXVILLE, TN 37920
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/2/12 REMOVED SHIP ADD (WAS 1924 ALCOA HWY, KNOXVILLE, TN 37920), ADDED BILL ADD, ADDED NPI#
04/03/2012
May 2025
May 2025
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