340B Drug Pricing Program Database
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DSH460009AF University of Utah (Terminated)
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Main Details
Name
University of Utah
Subdivision Name
South Ogden Health Center - Mountain View Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460009AF
Medicare Provider Number
460009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/3/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/5/2018
Last Recertification Date
9/14/2022
Termination Date
Termination Reason
7/1/2023
Site closure
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
5957 South Fashion Point Drive
Ste 101
Ogden, UT 84403-5180
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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