340B Drug Pricing Program Database
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DSH440015AA UNIVERSITY OF TENNESSEE MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF TENNESSEE MEDICAL CENTER
Subdivision Name
UT INFUSION (COVID) - COVID
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH440015AA
Medicare Provider Number
440015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/2/2022
Last Recertification Date
Termination Date
Termination Reason
4/1/2023
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
1928 ALCOA HWY
STE B100
KNOXVILLE, TN 37920-1506
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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