340B Drug Pricing Program Database
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DSH460009AE University of Utah (Active)
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Main Details
Name
University of Utah
Subdivision Name
Geriatric Clinic at Madsen Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460009AE
Medicare Provider Number
460009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/12/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/9/2016
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
University of Utah Hospitals and Clinics
Charlton Gordon Park, Chief Financial Officer
(801) 585-1325
Primary Contact
University of Utah Health
Sara Bamford, 340B Pharmacy Manager
(801) 587-1229
Addresses
Street Address
555 Foothill Blvd
Salt Lake City, UT 84112-1106
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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