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DSH170040DP UNIVERSITY OF KANSAS HOSPITAL (Active)
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Main Details
Name
UNIVERSITY OF KANSAS HOSPITAL
Subdivision Name
ComKC Med Plaza Int Med
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170040DP
Medicare Provider Number
170040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/11/2019
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
10787 Nall Ave.
Level 3
Suite 310
Overland Park, KS 66211-1301
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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