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DSH440039R Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic (Terminated)
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Main Details
Name
Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
Subdivision Name
NORTHCREST VICC CANCER CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440039R
Medicare Provider Number
440039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/1/2013
Last Recertification Date
8/26/2022
Termination Date
Termination Reason
1/1/2023
Site closure
Contacts
Authorizing Official
Vanderbilt University Medical Center
James Edgar Newman, Vice President
(615) 293-3406
Primary Contact
Vanderbilt University Medical Center
JIMMY N. HAYMAN, Chief Pharmacy Officer
(615) 322-0716 Ext: 6153220716
Addresses
Street Address
500 NORTHCREST DRIVE, SUITE 521
SPRINGFIELD, TN 37172
Billing Address
VANDERBILT UNIVERSITY HOSPITAL AND CLINIC
726 MELROSE AVE
NASHVILLE, TN 37211-2151
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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