340B Drug Pricing Program Database
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DSH460009AD University of Utah (Terminated)
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Main Details
Name
University of Utah
Subdivision Name
Farmington Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460009AD
Medicare Provider Number
460009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/7/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/29/2016
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
165 N University Ave
Farmington, UT 84025
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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