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DSH440039AM Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic (Active)
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Main Details
Name
Vanderbilt University Medical Center d/b/a Vanderbilt University Hospital and Clinic
Subdivision Name
Vanderbilt Internal Medicine Clinic - Adult Primary Care Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440039AM
Medicare Provider Number
440039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/22/2018
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Vanderbilt University Medical Center
James Edgar Newman, Vice President
(615) 293-3406
Primary Contact
DSH440039
Thomas Mark Sullivan, Chief Pharmacy Officer
(615) 343-9595
Addresses
Street Address
719 Thompson Lane
Suite 20400
Nashville, TN 37204
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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