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DSH170040CQ UNIVERSITY OF KANSAS HOSPITAL (Active)
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Main Details
Name
UNIVERSITY OF KANSAS HOSPITAL
Subdivision Name
Interventional Radiology CA
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170040CQ
Medicare Provider Number
170040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/3/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/8/2019
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
University of Kansas Health System
Rick Couldry, Vice-President, Pharmacy and Clinical Professions
(913) 588-2301
Primary Contact
The University of Kansas Hospital
Todd Holt, Pharmacy Operations Manager
(913) 945-8291
Addresses
Street Address
3825 Cambridge St.
Level 2
Kansas City, KS 66103-2271
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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