Covered Entity Details

DSH450686D UNIVERSITY MEDICAL CENTER (Active) - information as of 4/25/2025 6:29:25 PM

Main Details

Name

UNIVERSITY MEDICAL CENTER

Subdivision Name

URGENT CARE CENTER AT UMC - Urgent Care

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450686D

Medicare Provider Number

450686

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/4/2023

Participating Start Date

4/1/2023

Participating Approval Date

1/5/2023

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

University Medical Center
John Lowe, Vice President of Support Services
(806) 775-8516

Primary Contact

University Medical Center
Courtney Armstrong, Director of Pharmacy
(806) 775-9391

Addresses

Street Address

808 JOLIET AVE
LUBBOCK, TX 79415-1149

Billing Address

University Medical Center
602 Indiana Ave
Lubbock, TX 79415

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	137999206,250296	1619561537,1679521652,1821087164,1861175564,1831820893,1417729708
NM	A9745	1619561537,1679521652,1821087164,1417729708,1831820893,1861175564

Shipping Addresses

Shipping Address 1

University Medical Center
602 Indiana Ave
Lubbock, TX 79415

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
DSH450686A	Child	DSH	UNIVERSITY MEDICAL CENTER	Lubbock County Hospital District - EMS	5505 Marsha Sharp Freeway	Lubbock	TX	Active
DSH450686B	Child	DSH	UNIVERSITY MEDICAL CENTER	Ambulatory Care Center	808 Joliet Avenue Suite 120	Lubbock	TX	Active
DSH450686C	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC OUTPATIENT GI CENTER - Gastroenterology	10202 QUAKER AVE	LUBBOCK	TX	Active
DSH450686D	Child	DSH	UNIVERSITY MEDICAL CENTER	URGENT CARE CENTER AT UMC - Urgent Care	808 JOLIET AVE	LUBBOCK	TX	Active
DSH450686E	Child	DSH	UNIVERSITY MEDICAL CENTER	Medication Therapy Management Center - Medication Therapy Management	7105 Kewanee Avenue	Lubbock	TX	Active
DSH450686F	Child	DSH	UNIVERSITY MEDICAL CENTER	Medication Therapy Management Clinic - ACC - Medication Therapy Management Clinic - Medication Therapy Management	808 Joliet Avenue	Lubbock	TX	Active
DSH450686G	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW Radiology - Diagnostic - 6140	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686H	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW Operating Room - 6021	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686J	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW Cath Lab - 6090	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686K	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW Radiology Special Procedures 6142	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686L	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW MRI - 6143	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686M	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW Ultrasound Lab - 6149	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686N	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW Cat Scan - 6150	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686P	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW Ambulatory Infusion - 6152	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686Q	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - Medication Therapy Management Clinic - Health and Wellness Hospital	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686R	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC HEALTH & WELLNESS HOSPITAL - HW Emergency Center - 6230	11011 SLIDE RD	LUBBOCK	TX	Active
DSH450686S	Child	DSH	UNIVERSITY MEDICAL CENTER	UMC Health & Wellness Hospital - Urgent Care Clinic	11102 Headquarters Drive	Lubbock	TX	Active
DSH450686T	Child	DSH	UNIVERSITY MEDICAL CENTER	LUBBOCK COUNTY DETENTION CENTER - General Medicine	3502 N Holly St	Lubbock	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Recertification		1417729708	8/20/2024 10:27 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	8/20/2024 10:27 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1831820893	8/20/2024 10:27 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	8/20/2024 10:27 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1861175564	8/20/2024 10:27 AM
Medicaid Billing	NPI: State	Insert	Recertification		NM	8/20/2024 10:27 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 6:34:27 PM	8/20/2024 10:27:23 AM	8/20/2024 10:27 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1861175564	10/31/2023 10:06 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	10/31/2023 10:06 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1831820893	10/31/2023 10:06 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	10/31/2023 10:06 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1417729708	10/31/2023 10:06 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		TX	10/31/2023 10:06 AM
Details	Last Recertification Date	Update	Recertification		8/16/2023 6:34:27 PM	8/16/2023 6:34 PM
Details	State	Update		Approved	Active	4/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Lowe, John Vice President of Support Services University Medical Center 8067758516	1/5/2023 4:01 PM
Details	340B ID	Update	New Registration		DSH450686D	1/5/2023 4:01 PM
Details	Entity Subname	Update	New Registration	URGENT CARE CENTER AT UMC	URGENT CARE CENTER AT UMC - Urgent Care	1/5/2023 4:01 PM
Dates	Participating Approval Date	Update	New Registration		1/5/2023 4:01:18 PM	1/5/2023 4:01 PM
Details	State	Update	New Registration	Pending	Approved	1/5/2023 4:01 PM
Dates	Signed By Date	Update	New Registration		1/5/2023 9:46:47 AM	1/5/2023 4:01 PM
Dates	Start Date	Update	New Registration		4/1/2023 12:00:00 AM	1/5/2023 4:01 PM
Addresses	Main Address	Insert	New Registration		808 JOLIET AVE LUBBOCK, TX 79415-1149	1/4/2023 1:58 PM
Addresses	Billing Address	Insert	New Registration		University Medical Center 602 Indiana Ave Lubbock, TX 79415	1/4/2023 1:58 PM
Addresses	Shipping Address	Insert	New Registration		University Medical Center 602 Indiana Ave Lubbock, TX 79415	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		137999206	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		250296	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		A9745	1/4/2023 1:58 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		NM	1/4/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619561537	1/4/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/4/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1679521652	1/4/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/4/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821087164	1/4/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	1/4/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619561537	1/4/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		NM	1/4/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1679521652	1/4/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		NM	1/4/2023 1:58 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821087164	1/4/2023 1:58 PM
Medicaid Billing	NPI: State	Insert	New Registration		NM	1/4/2023 1:58 PM
Contacts	Primary Contact	Insert	New Registration		Armstrong, Courtney Director of Pharmacy University Medical Center 8067759391	1/4/2023 1:58 PM
Contacts	Authorizing Official	Insert	New Registration		Lowe, John Vice President of Support Services University Medical Center 8067758516	1/4/2023 1:58 PM
Details	Assistance Received From Date	Insert	New Registration			1/4/2023 1:58 PM
Details	Assistance Received To Date	Insert	New Registration			1/4/2023 1:58 PM
Details	Last Recertification Date	Insert	New Registration			1/4/2023 1:58 PM
Details	Grant Number	Insert	New Registration			1/4/2023 1:58 PM
Details	340B ID	Insert	New Registration			1/4/2023 1:58 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/4/2023 1:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/4/2023 1:58 PM
Details	Medicare Provider Number	Insert	New Registration		450686	1/4/2023 1:58 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY MEDICAL CENTER	1/4/2023 1:58 PM
Details	NOFO Number	Insert	New Registration			1/4/2023 1:58 PM
Details	Program Code	Insert	New Registration		DSH	1/4/2023 1:58 PM
Details	Entity Subname	Insert	New Registration		URGENT CARE CENTER AT UMC	1/4/2023 1:58 PM
Dates	Participating Approval Date	Insert	New Registration			1/4/2023 1:58 PM
Details	State	Insert	New Registration		Pending	1/4/2023 1:58 PM
Dates	Registration Date	Insert	New Registration		1/4/2023 1:58:09 PM	1/4/2023 1:58 PM
Dates	Signed By Date	Insert	New Registration			1/4/2023 1:58 PM
Dates	Start Date	Insert	New Registration			1/4/2023 1:58 PM
Terminations	Termination Comments	Insert	New Registration			1/4/2023 1:58 PM
Terminations	Termination Date	Insert	New Registration			1/4/2023 1:58 PM
Terminations	Termination Effective Date	Insert	New Registration			1/4/2023 1:58 PM
Terminations	Termination Reason	Insert	New Registration			1/4/2023 1:58 PM