340B Drug Pricing Program Database
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DSH460009W University of Utah (Terminated)
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Main Details
Name
University of Utah
Subdivision Name
Clinical Neuroscience Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460009W
Medicare Provider Number
460009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2012
Participating Start Date
1/1/2013
Participating Approval Date
10/18/2012
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
Kavish Choudhary, Senior Pharmacy Director
(801) 585-0186
Addresses
Street Address
175 North Medical Drive East
Salt Lake City, UT 84132
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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