340B Drug Pricing Program Database
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DSH460009AG University of Utah (Terminated)
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Main Details
Name
University of Utah
Subdivision Name
Craig H. Neilsen - Outpatient Rehab Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460009AG
Medicare Provider Number
460009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2019
Participating Start Date
7/1/2019
Participating Approval Date
6/5/2019
Last Recertification Date
9/5/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
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
85 North Medical Drive
Salt Lake City, UT 84132
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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