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DSH170040AA KANSAS UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
KANSAS UNIVERSITY HOSPITAL
Subdivision Name
Indian Creek Surgery Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170040AA
Medicare Provider Number
170040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/11/2017
Last Recertification Date
11/29/2017
Termination Date
Termination Reason
10/1/2018
Other
Contacts
Authorizing Official
University of Kansas Health System
Rick Couldry, Vice-President, Pharmacy and Clinical Professions
(913) 588-2301
Primary Contact
University of Kansas Health System
Rick Couldry, Vice-President, Pharmacy and Clinical Professions
(913) 588-2301
Addresses
Street Address
10730 Nall Avenue
Suite 202
Overland Park, KS 66211
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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