Covered Entity Details

DSH450024P UNIVERSITY MEDICAL CENTER OF EL PASO (Approved) - information as of 6/19/2025 11:48:47 PM

Main Details

Name

UNIVERSITY MEDICAL CENTER OF EL PASO

Subdivision Name

EL PASO COUNTY HOSPITAL DISTRICT - Surgical Hospital

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH450024P

Medicare Provider Number

450024

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/4/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/7/2025

Last Recertification Date

Contacts

Authorizing Official

University Medical Center of El Paso
MICHAEL NUNEZ, CFO
(915) 521-7626

Primary Contact

UNIVERSITY MEDICAL CENTER OF EL PASO
DAVID CHAN, Asst Administrator Pharmacy Services
(915) 521-7662

Addresses

Street Address

1416 GEORGE DIETER DR
EL PASO, TX 79936-7601

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TX	138951211	1316936990

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH450024A	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	UNIVERSITY MEDICAL CENTER - NORTHEAST	9839 KENWORTHY ST	EL PASO	TX	Active
DSH450024B	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	UNIVERSITY MEDICAL CENTER YSLETA	300 S ZARAGOZA RD.	EL PASO	TX	Active
DSH450024C	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	University Medical Center Dieter	1485 George Dieter Dr, STE 107	El Paso	TX	Active
DSH450024D	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	University Medical Center Fabens	101 Potasio ST	Fabens	TX	Active
DSH450024E	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	UMC Neighborhood Health Center Crossroads	5021 Crossroads Drive	El Paso	TX	Terminated
DSH450024F	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	University Medical Center East	1521 Joe Battle Blvd	EL PASO	TX	Active
DSH450024G	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	NEUROSURGICAL CARE CLINIC	4824 ALBERTA AVE	EL PASO	TX	Active
DSH450024H	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	Mattox Clinic	3700 Mattox Street	El Paso	TX	Active
DSH450024J	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	Delta Clinic	6314 Delta Drive	El Paso	TX	Terminated
DSH450024K	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	UNIVERSITY MEDICAL CENTER West	6600 N Desert Blvd	EL PASO	TX	Active
DSH450024L	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	UMC of El Paso - Northeast Emergency Department - Emergency	4669 Cohen Avenue	El Paso	TX	Active
DSH450024M	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	UMC of El Paso - East Emergency Department - Emergency	1521 Joe Battle Blvd	El Paso	TX	Active
DSH450024N	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	EL PASO COUNTY HOSPITAL DISTRICT - UMC Surgical Center West	4642 N MESA STREET	EL PASO	TX	Approved
DSH450024P	Child	DSH	UNIVERSITY MEDICAL CENTER OF EL PASO	EL PASO COUNTY HOSPITAL DISTRICT - Surgical Hospital	1416 GEORGE DIETER DR	EL PASO	TX	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		NUNEZ, MICHAEL CFO University Medical Center of El Paso 9155217626	5/7/2025 8:07 AM
Details	340B ID	Update	New Registration		DSH450024P	5/7/2025 8:07 AM
Details	Entity Subname	Update	New Registration	EL PASO COUNTY HOSPITAL DISTRICT	EL PASO COUNTY HOSPITAL DISTRICT - Surgical Hospital	5/7/2025 8:07 AM
Dates	Participating Approval Date	Update	New Registration		5/7/2025 8:07:48 AM	5/7/2025 8:07 AM
Details	State	Update	New Registration	Pending	Approved	5/7/2025 8:07 AM
Dates	Signed By Date	Update	New Registration		4/7/2025 11:34:45 AM	5/7/2025 8:07 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/7/2025 8:07 AM
Addresses	Main Address	Insert	New Registration		1416 GEORGE DIETER DR EL PASO, TX 79936-7601	4/4/2025 11:18 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 11:18 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138951211	4/4/2025 11:18 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	4/4/2025 11:18 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1316936990	4/4/2025 11:18 AM
Medicaid Billing	NPI: State	Insert	New Registration		TX	4/4/2025 11:18 AM
Contacts	Authorizing Official	Insert	New Registration		NUNEZ, MICHAEL CFO University Medical Center of El Paso 9155217626	4/4/2025 11:18 AM
Contacts	Primary Contact	Insert	New Registration		CHAN, DAVID Asst Administrator Pharmacy Services UNIVERSITY MEDICAL CENTER OF EL PASO 9155217662	4/4/2025 11:18 AM
Details	Assistance Received From Date	Insert	New Registration			4/4/2025 11:18 AM
Details	Assistance Received To Date	Insert	New Registration			4/4/2025 11:18 AM
Details	Last Recertification Date	Insert	New Registration			4/4/2025 11:18 AM
Details	Grant Number	Insert	New Registration			4/4/2025 11:18 AM
Details	340B ID	Insert	New Registration			4/4/2025 11:18 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2025 11:18 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2025 11:18 AM
Details	Medicare Provider Number	Insert	New Registration		450024	4/4/2025 11:18 AM
Details	Entity Name	Insert	New Registration		UNIVERSITY MEDICAL CENTER OF EL PASO	4/4/2025 11:18 AM
Details	NOFO Number	Insert	New Registration			4/4/2025 11:18 AM
Details	Program Code	Insert	New Registration		DSH	4/4/2025 11:18 AM
Details	Entity Subname	Insert	New Registration		EL PASO COUNTY HOSPITAL DISTRICT	4/4/2025 11:18 AM
Dates	Participating Approval Date	Insert	New Registration			4/4/2025 11:18 AM
Details	State	Insert	New Registration		Pending	4/4/2025 11:18 AM
Dates	Registration Date	Insert	New Registration		4/4/2025 11:18:40 AM	4/4/2025 11:18 AM
Dates	Signed By Date	Insert	New Registration			4/4/2025 11:18 AM
Dates	Start Date	Insert	New Registration			4/4/2025 11:18 AM
Terminations	Termination Comments	Insert	New Registration			4/4/2025 11:18 AM
Terminations	Termination Date	Insert	New Registration			4/4/2025 11:18 AM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2025 11:18 AM
Terminations	Termination Reason	Insert	New Registration			4/4/2025 11:18 AM