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DSH170040AB KANSAS UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
KANSAS UNIVERSITY HOSPITAL
Subdivision Name
MATCS ICC / MATCS - Lung Nodule
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170040AB
Medicare Provider Number
170040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/17/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/24/2017
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 AVE
STE 201
OVERLAND PARK, KS 66211-1210
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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