340B Drug Pricing Program Database
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DSH440015Y UNIVERSITY OF TENNESSEE MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF TENNESSEE MEDICAL CENTER
Subdivision Name
UNIVERSITY DIAG AT NORTHSHORE - Diagnostics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440015Y
Medicare Provider Number
440015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2021
Participating Start Date
1/1/2022
Participating Approval Date
12/3/2021
Last Recertification Date
9/14/2022
Termination Date
Termination Reason
1/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
University of Tennessee Medical Center
Kim C. Mason, Vice President, Pharmacy and Research
(865) 305-9124
Primary Contact
University of Tennessee Medical Center
Ivis Shane Trent, 340B Pharmacist
(865) 305-9166
Addresses
Street Address
1975 TOWN CENTER BLVD
STE 206
KNOXVILLE, TN 37922
Billing Address
University Health System, Inc
Accounts Payable
PO Box 32849
Knoxville, TN 37930-2849
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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