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DSH170040FN UNIVERSITY OF KANSAS HOSPITAL (Active)
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Main Details
Name
UNIVERSITY OF KANSAS HOSPITAL
Subdivision Name
INDIAN CREEK CAMPUS - ICC SPINE/SPORTS MED RADIOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH170040FN
Medicare Provider Number
170040
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/5/2021
Participating Start Date
4/1/2021
Participating Approval Date
2/3/2021
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
10730 Nall Ave
Level 2
Suite 200
OVERLAND PARK, KS 66211
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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