Covered Entity Details

DSH450024M UNIVERSITY MEDICAL CENTER OF EL PASO (Active) - information as of 4/27/2025 12:48:35 AM

Main Details

Name

UNIVERSITY MEDICAL CENTER OF EL PASO

Subdivision Name

UMC of El Paso - East Emergency Department - Emergency

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450024M

Medicare Provider Number

450024

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/5/2021

Participating Start Date

1/1/2022

Participating Approval Date

10/6/2021

Last Recertification Date

8/13/2024

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

1521 Joe Battle Blvd
Suite B
El Paso, TX 79936

Billing Address

University Medical Center of El Paso
4815 ALAMEDA AVE.
EL PASO, TX 79905

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

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	PC Change Request	Lewis, Myron Ray Director of Pharmacy University Medical Center of El Paso 9155217662	CHAN, DAVID Asst Administrator Pharmacy Services UNIVERSITY MEDICAL CENTER OF EL PASO 9155217662	10/31/2024 7:06 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 9:47:52 AM	8/13/2024 8:29:05 AM	8/13/2024 8:29 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 9:00:32 AM	8/16/2023 9:47:52 AM	8/16/2023 9:47 AM
Details	Last Recertification Date	Update	Recertification		8/31/2022 9:00:32 AM	8/31/2022 9:00 AM
Details	State	Update		Approved	Active	1/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		NUNEZ, MICHAEL CFO University Medical Center of El Paso 9155217626	10/6/2021 7:04 AM
Details	340B ID	Update	New Registration		DSH450024M	10/6/2021 7:04 AM
Details	Entity Subname	Update	New Registration	UMC of El Paso - East Emergency Department	UMC of El Paso - East Emergency Department - Emergency	10/6/2021 7:04 AM
Dates	Participating Approval Date	Update	New Registration		10/6/2021 7:04:05 AM	10/6/2021 7:04 AM
Details	State	Update	New Registration	Pending	Approved	10/6/2021 7:04 AM
Dates	Signed By Date	Update	New Registration		10/5/2021 12:32:19 PM	10/6/2021 7:04 AM
Dates	Start Date	Update	New Registration		1/1/2022 12:00:00 AM	10/6/2021 7:04 AM
Addresses	Main Address	Insert	New Registration		1521 Joe Battle Blvd Suite B El Paso, TX 79936	10/5/2021 11:21 AM
Addresses	Billing Address	Insert	New Registration		University Medical Center of El Paso 4815 ALAMEDA AVE. EL PASO, TX 79905	10/5/2021 11:21 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/5/2021 11:21 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		138951211	10/5/2021 11:21 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	10/5/2021 11:21 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1316936990	10/5/2021 11:21 AM
Medicaid Billing	NPI: State	Insert	New Registration		TX	10/5/2021 11:21 AM
Contacts	Primary Contact	Insert	New Registration		Lewis, Myron Ray Director of Pharmacy University Medical Center of El Paso 9155217662	10/5/2021 11:21 AM
Contacts	Authorizing Official	Insert	New Registration		NUNEZ, MICHAEL CFO University Medical Center of El Paso 9155217626	10/5/2021 11:21 AM
Details	Assistance Received From Date	Insert	New Registration			10/5/2021 11:21 AM
Details	Assistance Received To Date	Insert	New Registration			10/5/2021 11:21 AM
Details	Last Recertification Date	Insert	New Registration			10/5/2021 11:21 AM
Details	Grant Number	Insert	New Registration			10/5/2021 11:21 AM
Details	340B ID	Insert	New Registration			10/5/2021 11:21 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/5/2021 11:21 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/5/2021 11:21 AM
Details	Medicare Provider Number	Insert	New Registration		450024	10/5/2021 11:21 AM
Details	Entity Name	Insert	New Registration		UNIVERSITY MEDICAL CENTER OF EL PASO	10/5/2021 11:21 AM
Details	NOFO Number	Insert	New Registration			10/5/2021 11:21 AM
Details	Program Code	Insert	New Registration		DSH	10/5/2021 11:21 AM
Details	Entity Subname	Insert	New Registration		UMC of El Paso - East Emergency Department	10/5/2021 11:21 AM
Dates	Participating Approval Date	Insert	New Registration			10/5/2021 11:21 AM
Details	State	Insert	New Registration		Pending	10/5/2021 11:21 AM
Dates	Registration Date	Insert	New Registration		10/5/2021 11:21:01 AM	10/5/2021 11:21 AM
Dates	Signed By Date	Insert	New Registration			10/5/2021 11:21 AM
Dates	Start Date	Insert	New Registration			10/5/2021 11:21 AM
Terminations	Termination Comments	Insert	New Registration			10/5/2021 11:21 AM
Terminations	Termination Date	Insert	New Registration			10/5/2021 11:21 AM
Terminations	Termination Effective Date	Insert	New Registration			10/5/2021 11:21 AM
Terminations	Termination Reason	Insert	New Registration			10/5/2021 11:21 AM