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DSH460009GP University of Utah (Terminated)
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Main Details
Name
University of Utah
Subdivision Name
UNIVERSITY OF UTAH HOSPITALS AND CL - CC REDWOOD DISASTER PREP
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460009GP
Medicare Provider Number
460009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/27/2023
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
University of Utah Hospitals and Clinics
Charlton Gordon Park, Chief Financial Officer
(801) 585-1325
Primary Contact
University of Utah Hospitals and Clinics
Tom Sanders, Support Services Pharmacist
(801) 581-2147
Addresses
Street Address
1525 W 2100 S
SALT LAKE CITY, UT 84119-1407
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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