Covered Entity Details

DSH450018LC UNIVERSITY OF TEXAS MEDICAL BRANCH (Active) - information as of 4/24/2025 10:16:08 PM

Main Details

Name

UNIVERSITY OF TEXAS MEDICAL BRANCH

Subdivision Name

Crain Unit - Medical (GV) - CMC TDCJ

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH450018LC

Medicare Provider Number

450018

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/4/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/15/2024

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

UTMB
Carolanda B Woodgett, Senior Vice President and Chief Legal Officer
(409) 747-8735

Primary Contact

University Of Texas Medical Branch
Sarah Renee Reynolds, UTMB 340B Program Analyst
(936) 222-7312

Addresses

Street Address

1401 State School Road
Gatesville, TX 76599

Billing Address

UTMB-CMC Department of Pharmacy
2400 Avenue I
Huntsville, TX 77340

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?
No

Shipping Addresses

Shipping Address 1

UTMB-CMC Department of Pharmacy
2400 Avenue I
Huntsville, TX 77340

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
DSH450018A	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB - CMC CLINIC	2400 AVENUE I	HUNTSVILLE	TX	Active
DSH450018AI	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CBC Alvin Primary & Specialty Care	2020 EAST HIGHWAY 6	ALVIN	TX	Active
DSH450018AJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	League City PEDIATRIC AND ADULT PRIMARY CARE	6465 South Shore Boulevard	LEAGUE CITY	TX	Active
DSH450018AK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	PEDIATRIC AND ADULT PRIMARY CARE, FRIENDSWOOD	1715 South Friendswood Drive	FRIENDSWOOD	TX	Active
DSH450018AL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB TEXAS CITY PEDIATRIC CLINIC	10121 EMMETT F LOWRY EXPRESSWAY	TEXAS CITY	TX	Terminated
DSH450018AM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB TEXAS CITY CBC FAMILY HEALTH	10121 EMMETT F LOWRY EXPRESSWAY	TEXAS CITY	TX	Active
DSH450018AR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC PAIN MANAGEMENT CLINIC	2660 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018AS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB MAINLAND CARDIOLOGY	10121 EMMETT F LOWRY EXPRESSWAY	TEXAS CITY	TX	Terminated
DSH450018AT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB MEDICAL SPECIALTIES FRIENDSWOOD - ENDOCRINOLOGY & RHEUMATOLOGY CLINIC	121 W. PARKWOOD	FRIENDSWOOD	TX	Terminated
DSH450018AX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB EAR, NOSE & THROAT	1600 West LEAGUE CITY PARKWAY	LEAGUE CITY	TX	Active
DSH450018AY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women’s Services & Pediatrics, Angleton	1108 EAST MULBERRY STREET	ANGLETON	TX	Active
DSH450018AZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women’s Services & Pediatrics, Beaumont	195 North 11th Street	BEAUMONT	TX	Active
DSH450018BA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women’s Services & Pediatrics, Conroe	701 EAST DAVIS STREET, SUITE A	CONROE	TX	Active
DSH450018BB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB DICKINSON RMCHP	3828 Hughes Court	Dickinson	TX	Terminated
DSH450018BC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB GALVESTON RMCHP	7TH FLOOR UHC	GALVESTON	TX	Terminated
DSH450018BE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women’s Services & Pediatrics, Katy	511 PARK GROVE DRIVE	KATY	TX	Active
DSH450018BF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB NACOGDOCHES RMCHP	206 MIMS PLAZA	NACOGDOCHES	TX	Terminated
DSH450018BG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women's Services & Pediatrics, New Caney	21134 US Highway 59	NEW CANEY	TX	Active
DSH450018BH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women's Services & Pediatrics, Orange	2014 North 10th Street	ORANGE	TX	Active
DSH450018BI	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women's Services & Pediatrics, Pasadena	3737 RED BLUFF, SUITE 150	PASADENA	TX	Active
DSH450018BJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women's Services & Pediatrics, Pearland	2750 EAST BROADWAY STREET	PEARLAND	TX	Active
DSH450018BK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women’s Services & Pediatrics, Sugar Land	14823 Southwest Freeway	Sugarland	TX	Active
DSH450018BL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women's Services & Pediatrics, Texas City	9300 EMMETT F. LOWRY EXPRESSWAY	TEXAS CITY	TX	Active
DSH450018BO	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB ISLAND PEDIATRICS WEST	6416 BROADWAY STREET	GALVESTON	TX	Active
DSH450018BQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB ISLAND URGENT CARE	6416 BROADWAY STREET	GALVESTON	TX	Active
DSH450018BR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Webster Psychiatry Clinic	400 TEXAS AVENUE NORTH	WEBSTER	TX	Active
DSH450018BS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC Infusion Center	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018BT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH FAMILY MEDICINE DICKINSON	2401 WEST FM 646	DICKINSON	TX	Active
DSH450018BV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC Medicine Specialties Clinic	2660 Gulf Freeway South	League City	TX	Active
DSH450018BW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC Stark Diabetes Clinic	2660 Gulf Freeway South	League City	TX	Active
DSH450018BX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC Cardiology	2660 Gulf Freeway South	League City	TX	Terminated
DSH450018BY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC Transplant Clinic	2660 Gulf Freeway South	League City	TX	Active
DSH450018BZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Bay Colony Pediatric Primary Care	2785 Gulf Freeway South	League City	TX	Active
DSH450018CA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC Dermatology Clinic	2660 Gulf Freeway South	League City	TX	Active
DSH450018CB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Oral and Maxillofacial Surgery Clinic	1600 W. League City Parkway	League City	TX	Active
DSH450018CC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Women’s Services & Pediatrics, McAllen	620 SOUTH BROADWAY STREET	MCALLEN	TX	Active
DSH450018CD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC SURGICAL SPECIALTIES CLINIC	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018CE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC Digestive Health	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018CF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VL PELVIC HEALTH & CONTINENCE CENTER	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Terminated
DSH450018CG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC ORTHOPEDIC CLINIC	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018CH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CENTER FOR OBESITY AND METABOLIC SURGERY	2660 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Terminated
DSH450018CJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC ADVANCED IMAGING CENTER	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Terminated
DSH450018CK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC Surgery	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018CL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC Ophthalmology Clinic	2660 Gulf Freeway South	League City	TX	Active
DSH450018CM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC Urgent Care	2240 Gulf Freeway South	League City	TX	Active
DSH450018CN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CLC Women's Healthcare	250 Blossom Street	Webster	TX	Active
DSH450018CP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Orthopedics South Shore Harbour	3023 Marina Bay Drive	League City	TX	Terminated
DSH450018CQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Pediatric After-Hours Urgent Care South Shore	3023 Marina Bay Drive	League City	TX	Terminated
DSH450018CR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Family Medicine Island West	6710 Stewart Road	Galveston	TX	Active
DSH450018CS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Women's Health Webster	17448 Highway 3	Webster	TX	Terminated
DSH450018CT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Eye Center Friendswood	400 West Parkwood Avenue	Friendswood	TX	Active
DSH450018CU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - SURGICAL SERVICES	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018CV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - ANESTHESIOLOGY	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018CW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - PACU	132 E. HOSPITAL DRIVE	ANGLETON	TX	Terminated
DSH450018CX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - L&D	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018CY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - RAD XRAY	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018CZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - RAD ULTRASOUND	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - RAD CT SCAN	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - RESP/PULMONARY	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - OUTPATIENT IMAGING MRI	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - CARDIO PULMONARY	132 E. HOSPITAL DRIVE	ANGLETON	TX	Terminated
DSH450018DE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - NUCLEAR MEDICINE	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB COMMUNITY ADULT CLINIC	2000 TEXAS AVENUE	TEXAS CITY	TX	Terminated
DSH450018DG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - ER	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS - OBSERVATION	132 E. HOSPITAL DRIVE	ANGLETON	TX	Terminated
DSH450018DJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Texas City Ophthalmology	10121 Emmett F. Lowry Expressway	Texas City	TX	Active
DSH450018DK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Womens Healthcare Clinic - Angleton	146 East Hospital Drive	Angleton	TX	Active
DSH450018DL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Pediatric Primary Care - Angleton	146 East Hospital Drive	Angleton	TX	Active
DSH450018DM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Pediatrics Primary Care - Lake Jackson	208 Oak Drive South	Lake Jackson	TX	Active
DSH450018DN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH -ANGLETON / ENDOCRINOLOGY	146 East Hospital Drive.	ANGLETON	TX	Terminated
DSH450018DP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY HOSPITAL / LABOR AND DELIVERY	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Terminated
DSH450018DQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY HOSPITAL / RADIOLOGY SERVICES	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018DR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS / BREAST IMAGING	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY HOSPITAL / CARDIAC CATH LAB	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018DT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY HOSPITAL / RESPIRATORY SERVICES	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018DU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS / ECHO AND VASCULAR PROCEDURES	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH Hyperbaric Medicine	1804 FM 646 West	Dickinson	TX	Active
DSH450018DW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON Primary Care	146 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018DX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH SURGICAL SPECIALTIES WEBSTER / GENERAL, VASCULAR, PEDI SURGERY	17448 HIGHWAY 3	WEBSTER	TX	Terminated
DSH450018DY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY HOSPITAL - EMERGENCY SERVICES	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018DZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY HOSPITAL - OBSERVATION MED/SURG / OBSERVATION	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Terminated
DSH450018EA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Angleton Danbury Campus - Infusion Therapy	132 EAST HOSPITAL DRIVE	Angleton	TX	Active
DSH450018EB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health League City Campus - Echo Lab	2240 Gulf Freeway South	League City	TX	Active
DSH450018EC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Angleton Danbury Campus - Endoscopy	132 E Hospital Drive	Angleton	TX	Terminated
DSH450018ED	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health League City Campus - Endoscopy	2240 Gulf Freeway South	League City	TX	Terminated
DSH450018EE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Transplant Clinic McAllen	109 East Toronto Avenue	McAllen	TX	Active
DSH450018EF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health League City Campus - Breast Imaging	2240 Gulf Freeway South	League City	TX	Active
DSH450018EG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB WOMENS HEALTHCARE FRIENDSWOOD	1505 Winding Way Drive	FRIENDSWOOD	TX	Active
DSH450018EH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health League City Campus - Vascular Lab	2240 Gulf Freeway South	League City	TX	Terminated
DSH450018EJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH PRIMARY CARE WEBSTER	17448 HIGHWAY 3	Webster	TX	Active
DSH450018EK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health Angleton Danbury Campus - Blood Bank - Laboratory	132 EAST HOSPITAL DRIVE	Angleton	TX	Terminated
DSH450018EL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health League City Campus - Blood Bank - Laboratory	2240 Gulf Freeway South	League City	TX	Active
DSH450018EM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Alvin Urgent Care	2020 EAST HIGHWAY 6	Alvin	TX	Active
DSH450018EN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Texas City Urgent Care	10121 EMMETT F. LOWRY EXPRESSWAY	Texas City	TX	Active
DSH450018EP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CLEAR LAKE CAMPUS ANESTHESIA	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018EQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Texas City Urology Clinic	10121 EMMETT F. LOWRY EXPRESSWAY	Texas City	TX	Active
DSH450018ER	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS LABORATORY	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018ES	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS SURGICAL OPERATING SUITE - SURGERY	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018ET	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS CATH LAB - CARDIAC	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018EU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS PACU - SURGERY	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018EV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS NUCLEAR MEDICINE - RADIOLOGY	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018EW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC INTERVENTIONAL RADIOLOGY	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018EX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS ELECTROPHYSIOLOGY	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018EY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS INTERVENTIONAL RADIOLOGY	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018EZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS CATH/EP RECOVERY - CARDIAC	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018FA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS - ECHO LAB	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018FB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY CAMPUS NUCLEAR MEDICINE - RADIOLOGY	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018FC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH ANGLETON DANBURY CAMPUS LABORATORY	132 EAST HOSPITAL DRIVE	ANGLETON	TX	Active
DSH450018FD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY CAMPUS PULMONARY REHAB - RESPIRATORY	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018FE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS EMERGENCY DEPARMENT	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018FF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS LDRP	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018FG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS RESPIRATORY/PULMONARY	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018FH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Texas City ENT Clinic	10121 EMMETT F. LOWRY EXPRESSWAY	Texas City	TX	Active
DSH450018FJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH CLEAR LAKE CAMPUS PRE-OP - SURGERY	200 BLOSSOM STREET	WEBSTER	TX	Active
DSH450018FK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC MDA Cancer Center	2280 GULF FREEWAY SOUTH	League City	TX	Active
DSH450018FL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC CBC Primary Care	2660 Gulf Freeway South	League City	TX	Active
DSH450018FM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	CLC Adult Medical Specialties Clinic	250 Blossom Street	Webster	TX	Active
DSH450018FN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Beaumont Transplant Clinic	195 North 11th Street	Beaumont	TX	Active
DSH450018FP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	CLC Pedi Specialties	250 Blossom Street	Webster	TX	Active
DSH450018FQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	CBC Bay Colony Primary Care	2785 Gulf Freeway South	League City	TX	Active
DSH450018FR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	CLC Women's Specialties MOB	250 Blossom Street	Webster	TX	Active
DSH450018FS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP PEDIATRICS	400 Harborside Drive	Galveston	TX	Active
DSH450018FT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP PAIN MANAGEMENT CLINIC	400 Harborside Drive	Galveston	TX	Active
DSH450018FU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP FAMILY MEDICINE	400 Harborside Drive	Galveston	TX	Active
DSH450018FV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Galveston ENT	700 University Boulevard	Galveston	TX	Active
DSH450018FW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP Internal Medicine	400 Harborside Drive	Galveston	TX	Active
DSH450018FX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP Medicine Specialties	400 Harborside Drive	Galveston	TX	Active
DSH450018FY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP Orthopedics	400 Harborside Drive	Galveston	TX	Active
DSH450018FZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Galveston Ophthalmology	700 University Boulevard	Galveston	TX	Active
DSH450018GA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP Psychiatry	400 Harborside Drive	Galveston	TX	Active
DSH450018GB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Health CLC MOB Echo Lab - Cardiology	250 Blossom Street, 4th Floor	Webster	TX	Active
DSH450018GC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY HOSPITAL PACU - SURGERY	2240 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018GD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CBC South Shore Primary Care	3023 Marina Bay Drive	LEAGUE CITY	TX	Active
DSH450018GE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Webster Urgent Care	17448 Highway 3	Webster	TX	Active
DSH450018GF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CLC Continence & Pelvic Health	250 Blossom Street	Webster	TX	Active
DSH450018GG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC Aesthetics	2660 Gulf Freeway South	LEAGUE CITY	TX	Active
DSH450018GH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CLC - MOB Echo Lab - Cardiology	250 Blossom Street	Webster	TX	Terminated
DSH450018GJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Lake Jackson Women's Healthcare	215 Oak Drive South	Lake Jackson	TX	Active
DSH450018GK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB HEALTH LEAGUE CITY HOSPITAL ANESTHESIA - OR	2240 Gulf Freeway South	League City	TX	Active
DSH450018GL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB Angleton Medicine Specialties- MOB	2309 West Mulberry Street	Angleton	TX	Active
DSH450018GM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CBC Angleton Family Medicine - MOB	2309 West Mulberry Street	Angleton	TX	Active
DSH450018GN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CLC Infusion	250 Blossom Street	Webster	TX	Terminated
DSH450018GP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC X-Ray - radiology	2660 Gulf Freeway South	LEAGUE CITY	TX	Terminated
DSH450018GQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Lake Jackson Specialty Care	215 Oak Drive South	Lake Jackson	TX	Active
DSH450018GR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	CLC Adult Surgical Specialties	250 Blossom Street	Webster	TX	Active
DSH450018GS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Bay Colony Pediatric Specialties	2785 Gulf Freeway South	League City	TX	Active
DSH450018GT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Angleton Urgent Care	2309 West Mulberry Street	Angleton	TX	Active
DSH450018GU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Angleton Orthopedic	2309 West Mulberry Street	Angleton	TX	Active
DSH450018GV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Angleton Cardiology	146 East Hospital Drive	Angleton	TX	Active
DSH450018GW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Angleton Surgical Specialties	146 East Hospital Drive	Angleton	TX	Active
DSH450018GX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	CLC Pediatric ENT	250 Blossom Street	Webster	TX	Active
DSH450018GY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	TDCJ Mental Health - CMC TDCJ	200 River Pointe	Conroe	TX	Active
DSH450018GZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Austin MH HUB - CMC TDCJ	6300 La Calma Dr.	Austin	TX	Active
DSH450018HA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	TDCJ Medical - CMC TDCJ	1560 West Bay Area	Friendswood	TX	Active
DSH450018HB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Outpatient Services Admin - CMC TDCJ	12603 Southwest Freeway	Stafford	TX	Active
DSH450018HC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Inpatient Service Admin - CMC TDCJ	200 River Pointe	Conroe	TX	Active
DSH450018HD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Central Medical Admin - CMC TDCJ	200 River Pointe	Conroe	TX	Terminated
DSH450018HE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Support Services EMS - CMC TDCJ	262 FM 478	HUNTSVILLE	TX	Active
DSH450018HF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Ron Jackson Unit (BS) - CMC Other	611 FM 3254 Old Bangs Road	Brownwood	TX	Active
DSH450018HG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Polunsky Unit - Medical (TL) - CMC TDCJ	3872 FM 350 South	Livingston	TX	Active
DSH450018HH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	ODaniel - Medical (MV) - CMC TDCJ	2305 Ransom Road	Gatesville	TX	Active
DSH450018HJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Clemens Camp II - Medical (RV) - CMC TDCJ	6999 Retrieve	Angleton	TX	Active
DSH450018HK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Young - Medical (GC) - CMC TDCJ	5509 Attwater Avenue	Dickinson	TX	Active
DSH450018HL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Coleman Unit - Medical (LC) - CMC TDCJ	1400 Industrial Blvd	Lockhart	TX	Active
DSH450018HM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Cotulla Unit - Medical (N4) - CMC TDCJ	610 FM 625	Cotulla	TX	Active
DSH450018HN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Byrd Unit - Medical (DU) - CMC TDCJ	21 FM 247	HUNTSVILLE	TX	Active
DSH450018HP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Cole State Jail - Medical (CL) - CMC TDCJ	3801 Silo Road	Bonham	TX	Active
DSH450018HQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Wynne Unit - Medical (WY) - CMC TDCJ	810 FM 2821	HUNTSVILLE	TX	Active
DSH450018HR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Woodman Unit - Medical (WM) - CMC TDCJ	1210 Coryell City Rd	Gatesville	TX	Active
DSH450018HS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Willacy Unit - Medical (WI) - CMC TDCJ	1695 South Buffalo Drive	Raymondville	TX	Active
DSH450018HT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Wainwright Unit - Medical (EA) - CMC TDCJ	2665 Prison Road 1	Lovelady	TX	Active
DSH450018HU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Vance Unit - Medical (J2) - CMC TDCJ	2 Jester Road	Richmond	TX	Active
DSH450018HV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Travis County Unit - Medical (TI) - CMC TDCJ	8101 FM 969	Austin	TX	Active
DSH450018HW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Torres Unit - Medical (TE) - CMC TDCJ	125 Private Road 4303	Hondo	TX	Active
DSH450018HX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Terrell Unit - Medical (R3) - CMC TDCJ	1300 FM 655	Rosharon	TX	Active
DSH450018HY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Telford Unit - Medical (TO) - CMC TDCJ	3899 State Highway 98	New Boston	TX	Active
DSH450018HZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Stringfellow Unit - Medical (R2) - CMC TDCJ	1200 FM 655	Rosharon	TX	Active
DSH450018JA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Stiles Unit - Medical (ST) - CMC TDCJ	3060 FM 3514	Beaumont	TX	Active
DSH450018JB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Stevenson Unit - Medical (SB) - CMC TDCJ	1525 FM 766	Cuero	TX	Active
DSH450018JC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Skyview Unit - Medical (SV) - CMC TDCJ	379 FM 2972 W	Rusk	TX	Active
DSH450018JD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Segovia Unit - Medical (EN) - CMC TDCJ	1201 El Cibolo Road	Edinburg	TX	Active
DSH450018JE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Scott Unit - Medical (J4) - CMC TDCJ	4 Jester Road	Richmond	TX	Active
DSH450018JF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	San Saba Unit - Medical (N2) - CMC TDCJ	206 South Wallace Creek Road	San Saba	TX	Active
DSH450018JG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Ramsey I Unit - Medical (R1) - CMC TDCJ	1100 FM 655	Rosharon	TX	Active
DSH450018JH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Powledge Unit - Medical (B2) - CMC TDCJ	1400 FM 3452	Palestine	TX	Active
DSH450018JJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Plane State Jail - Medical (LJ) - CMC TDCJ	904 F.M. 686	Dayton	TX	Active
DSH450018JK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Pack Unit - Medical (P1) - CMC TDCJ	2400 Wallace Pack Rd	Navasota	TX	Active
DSH450018JL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Ney Unit - Medical (HF) - CMC TDCJ	114 Private Road 4303	Hondo	TX	Active
DSH450018JM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Murray Unit - Medical (LM) - CMC TDCJ	1916 North Hwy 36 Bypass	Gatesville	TX	Active
DSH450018JN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Michael Unit - Medical (MI) - CMC TDCJ	2664 FM 2054	Tennessee Colony	TX	Active
DSH450018JP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Memorial Unit - Medical (DA) - CMC TDCJ	59 Darrington Road	Rosharon	TX	Active
DSH450018JQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	McConnell Unit - Medical (ML) - CMC TDCJ	3001 South Emily Drive	Beeville	TX	Active
DSH450018JR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Marlin Unit - Medical (N1) - CMC TDCJ	2893 State Highway 6	Marlin	TX	Active
DSH450018JS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Lychner State Jail - Medical (AJ) - CMC TDCJ	2350 Atascocita Road	Humble	TX	Active
DSH450018JT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Luther Unit - Medical (P2) - CMC TDCJ	1800 Luther Dr	Navasota	TX	Active
DSH450018JU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Lopez Unit - Medical (RL) - CMC TDCJ	1203 El Cibolo Rd	Edinburg	TX	Active
DSH450018JV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Lindsey Unit - Medical (LN) - CMC TDCJ	1620 Post Oak Road	Jacksboro	TX	Active
DSH450018JW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Leblanc Unit - Medical (BA) - CMC TDCJ	3695 FM 3514	Beaumont	TX	Active
DSH450018JX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Kyle Unit - Medical (KY) - CMC TDCJ	23001 I.H. 35	Kyle	TX	Active
DSH450018JY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Kegans Unit - Medical (HM) - CMC TDCJ	707 Top Street	Houston	TX	Active
DSH450018JZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Johnston Unit - Medical (JT) - CMC TDCJ	703 Airport Road	Winnsboro	TX	Active
DSH450018K	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB VLTC Internal Medicine Clinic	2660 GULF FREEWAY SOUTH	LEAGUE CITY	TX	Active
DSH450018KA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Jester III Unit - Medical (J3) - CMC TDCJ	3 Jester Road	Richmond	TX	Active
DSH450018KB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Hutchins State Jail - Medical (HJ) - CMC TDCJ	1500 East Langdon Road	Dallas	TX	Active
DSH450018KC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Huntsville Unit - Medical (HV) - CMC TDCJ	815 12th Street	HUNTSVILLE	TX	Active
DSH450018KD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Hughes Unit - Medical (AH) - CMC TDCJ	3202 FM 929	Gatesville	TX	Active
DSH450018KE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Holliday Unit - Medical (NF) - CMC TDCJ	298 IH-45 North	HUNTSVILLE	TX	Active
DSH450018KF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Hodge Unit - Medical (HD) - CMC TDCJ	379 FM 2972 W	Rusk	TX	Active
DSH450018KG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Hobby Unit - Medical (HB) - CMC TDCJ	742 FM 712	Marlin	TX	Active
DSH450018KH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Hilltop Unit - Medical (HT) - CMC TDCJ	1500 State School Road	Gatesville	TX	Active
DSH450018KJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Hightower Unit - Medical (HI) - CMC TDCJ	902 FM 686	Dayton	TX	Active
DSH450018KK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Henley Unit - Medical (LT) - CMC TDCJ	7581 Hwy 321	Dayton	TX	Active
DSH450018KL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Hamilton Unit - Medical (JH) - CMC TDCJ	200 Lee Morrison Ln	Bryan	TX	Active
DSH450018KM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Halbert Unit - Medical (BB) - CMC TDCJ	800 Ellen Halbert Dr	Burnet	TX	Active
DSH450018KN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Gurney Transfer Facility - Medical (ND) - CMC TDCJ	1385 FM 3328	Palestine	TX	Active
DSH450018KP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Goree Unit - Medical (GR) - CMC TDCJ	7405 Hwy 75 South	HUNTSVILLE	TX	Active
DSH450018KQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Goodman Unit - Medical (GG) - CMC TDCJ	349 Private Road 8430	Jasper	TX	Active
DSH450018KR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Glossbrenner Unit - Medical (SO) - CMC TDCJ	5100 S FM 1329	San Diego	TX	Active
DSH450018KS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Gist State Jail Facility - Medical (BJ) - CMC TDCJ	3295 FM 3514	Beaumont	TX	Active
DSH450018KT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Garza Unit - Medical (NH) - CMC TDCJ	4250 Highway 202	Beeville	TX	Active
DSH450018KU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Ferguson Unit - Medical (FE) - CMC TDCJ	12120 Savage Drive	Midway	TX	Active
DSH450018KV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Estes Unit - Medical (VS) - CMC TDCJ	1100 Highway 1807	Venus	TX	Active
DSH450018KW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Estelle Unit - Medical (E2) - CMC TDCJ	264 FM 3478 RD	HUNTSVILLE	TX	Active
DSH450018KX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Ellis Unit - Medical (0E) - CMC TDCJ	1697 FM 980	HUNTSVILLE	TX	Active
DSH450018KY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	East Texas Treatment - Medical (XQ) - CMC TDCJ	900 Industrial Drive	Henderson	TX	Active
DSH450018KZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Duncan Facility - Medical (N6) - CMC TDCJ	1502 South First Street	Diboll	TX	Active
DSH450018LA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Dominguez State Jail - Medical (BX) - CMC TDCJ	6535 Cagnon Rd	San Antonio	TX	Active
DSH450018LB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Diboll Unit - Medical (DO) - CMC TDCJ	1604 South First	Diboll	TX	Active
DSH450018LC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Crain Unit - Medical (GV) - CMC TDCJ	1401 State School Road	Gatesville	TX	Active
DSH450018LD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Connally Unit Med Dept. - Medical (CY) - CMC TDCJ	899 FM 632	Kennedy	TX	Active
DSH450018LE	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Coffield Unit - Medical (CO) - CMC TDCJ	2661 FM 2054	Tennessee Colony	TX	Active
DSH450018LF	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Bell Unit - Medical (CV) - CMC TDCJ	901 East 5th Street	Cleveland	TX	Active
DSH450018LG	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Beto 1 Unit - Medical (0B) - CMC TDCJ	1391 FM 3328	Tennessee Colony	TX	Active
DSH450018LH	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Bradshaw Unit - Medical (BH) - CMC TDCJ	3900 W Loop 571	Henderson	TX	Active
DSH450018LJ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Boyd Unit - Medical (BY) - CMC TDCJ	200 Spur 113	Teague	TX	Active
DSH450018LK	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Bridgeport Unit - Medical (BR) - CMC TDCJ	400 North 10th Street	Bridgeport	TX	Active
DSH450018LL	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Briscoe Unit - Medical (DB) - CMC TDCJ	1459 West Highway 85	Dilley	TX	Active
DSH450018LM	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Clemens Unit - Medical (CN) - CMC TDCJ	11034 Highway 36	Brazoria	TX	Active
DSH450018LN	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	C. Moore Unit - Medical (CM) - CMC TDCJ	1700 North FM 87	Bonham	TX	Active
DSH450018LP	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	B. Moore Unit - Medical (BM) - CMC TDCJ	8500 FM N 3053	Overton	TX	Active
DSH450018LQ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Evin Unit - Medical (EV) - CMC Other	3801 E. Monte Cristo Rd.	Edinburg	TX	Active
DSH450018LR	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Gainesville Unit - Medical (GA) - CMC Other	1379 FM 678	Gainesville	TX	Active
DSH450018LS	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Giddings State School (GI) - CMC Other	1027 PVT Road 2261	Giddings	TX	Active
DSH450018LT	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	CMC Operations - CMC Other	200 River Pointe	Conroe	TX	Active
DSH450018LU	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	Lewis Unit - Medical (GL) - CMC TDCJ	777 FM 3497	Woodville	TX	Active
DSH450018LV	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	McLennan Unit - Medical (MN) - CMC Other	116 W Burleson Rd	Mart	TX	Active
DSH450018LW	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LC Adult Specialties	2240 Gulf Freeway South	League City	TX	Active
DSH450018LX	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP Neurology	400 Harborside Drive	Galveston	TX	Active
DSH450018LY	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CLC Spine Center	250 Blossom Street	Webster	TX	Active
DSH450018LZ	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB ANG Ambulatory Infusion Center	146 East Hospital Drive	Angleton	TX	Active
DSH450018MA	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB LCC Neurology - Neurology	2240 Gulf Freeway South	League City	TX	Approved
DSH450018MB	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP CBC Primary Care - Primary Care	400 Harborside Drive	Galveston	TX	Approved
DSH450018MC	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CLEAR LAKE CAMPUS - VASCULAR LAB	200 BLOSSOM STREET	WEBSTER	TX	Approved
DSH450018MD	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB PCP Cardiology - Cardiology	400 Harborside Drive	Galveston	TX	Approved
DSH450018ME	Child	DSH	UNIVERSITY OF TEXAS MEDICAL BRANCH	UTMB CLC Pulmonary Clinic - pulmonology	250 Blossom Street	Webster	TX	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		8/20/2024 5:25:11 PM	8/20/2024 5:25 PM
Contacts	Authorizing Official	Update	Profile Change Request	Woodgett, Carolanda B Associate Vice President and General Counsel ad interim UTMB 4097478735	Woodgett, Carolanda B Senior Vice President and Chief Legal Officer UTMB 4097478735	8/20/2024 8:53 AM
Contacts	Signed By	Update	Profile Change Request	Woodgett, Carolanda B Associate Vice President and General Counsel ad interim UTMB 4097478735	Woodgett, Carolanda B Senior Vice President and Chief Legal Officer UTMB 4097478735	8/20/2024 8:53 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Addresses	Shipping Address	Delete	New Registration	UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340		2/15/2024 9:05 AM
Addresses	Main Address	Insert	New Registration		1401 State School Road Gatesville, TX 76599	2/15/2024 9:05 AM
Addresses	Billing Address	Insert	New Registration		UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340	2/15/2024 9:05 AM
Addresses	Shipping Address	Insert	New Registration		UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340	2/15/2024 9:05 AM
Contacts	Signed By	Insert	New Registration		Woodgett, Carolanda B Associate Vice President and General Counsel ad interim UTMB 4097478735	2/15/2024 9:05 AM
Details	340B ID	Update	New Registration		DSH450018LC	2/15/2024 9:05 AM
Details	Entity Name	Update	New Registration	THE UNIVERSITY OF TEXAS MEDICAL BR.	UNIVERSITY OF TEXAS MEDICAL BRANCH	2/15/2024 9:05 AM
Details	Entity Subname	Update	New Registration	Crain Unit - Medical (GV)	Crain Unit - Medical (GV) - CMC TDCJ	2/15/2024 9:05 AM
Dates	Participating Approval Date	Update	New Registration		2/15/2024 9:05:13 AM	2/15/2024 9:05 AM
Details	State	Update	New Registration	Pending	Approved	2/15/2024 9:05 AM
Dates	Signed By Date	Update	New Registration		2/12/2024 8:58:36 AM	2/15/2024 9:05 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/15/2024 9:05 AM
Addresses	Shipping Address	Delete	New Registration	UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340		2/12/2024 8:58 AM
Addresses	Main Address	Insert	New Registration		1401 State School Road Gatesville, TX 76599	2/12/2024 8:58 AM
Addresses	Billing Address	Insert	New Registration		UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340	2/12/2024 8:58 AM
Addresses	Shipping Address	Insert	New Registration		UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340	2/12/2024 8:58 AM
Addresses	Main Address	Insert	New Registration		1401 State School Road Gatesville, TX 76599	1/9/2024 4:46 PM
Addresses	Billing Address	Insert	New Registration		UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340	1/9/2024 4:46 PM
Addresses	Shipping Address	Insert	New Registration		UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340	1/9/2024 4:46 PM
Addresses	Main Address	Insert	New Registration		1401 State School Road Gatesville, TX 76599	1/4/2024 3:43 PM
Addresses	Billing Address	Insert	New Registration		UTMB-CMC Department of Pharmacy 2400 Avenue I Huntsville, TX 77340	1/4/2024 3:43 PM
Contacts	Authorizing Official	Insert	New Registration		Woodgett, Carolanda B Associate Vice President and General Counsel ad interim UTMB 4097478735	1/4/2024 3:43 PM
Contacts	Primary Contact	Insert	New Registration		Reynolds, Sarah Renee UTMB 340B Program Analyst University Of Texas Medical Branch 9362227312	1/4/2024 3:43 PM
Details	Assistance Received From Date	Insert	New Registration			1/4/2024 3:43 PM
Details	Assistance Received To Date	Insert	New Registration			1/4/2024 3:43 PM
Details	Last Recertification Date	Insert	New Registration			1/4/2024 3:43 PM
Details	Grant Number	Insert	New Registration			1/4/2024 3:43 PM
Details	340B ID	Insert	New Registration			1/4/2024 3:43 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/4/2024 3:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/4/2024 3:43 PM
Details	Medicare Provider Number	Insert	New Registration		450018	1/4/2024 3:43 PM
Details	Entity Name	Insert	New Registration		THE UNIVERSITY OF TEXAS MEDICAL BR.	1/4/2024 3:43 PM
Details	NOFO Number	Insert	New Registration			1/4/2024 3:43 PM
Details	Program Code	Insert	New Registration		DSH	1/4/2024 3:43 PM
Details	Entity Subname	Insert	New Registration		Crain Unit - Medical (GV)	1/4/2024 3:43 PM
Dates	Participating Approval Date	Insert	New Registration			1/4/2024 3:43 PM
Details	State	Insert	New Registration		Pending	1/4/2024 3:43 PM
Dates	Registration Date	Insert	New Registration		1/4/2024 3:43:49 PM	1/4/2024 3:43 PM
Dates	Signed By Date	Insert	New Registration			1/4/2024 3:43 PM
Dates	Start Date	Insert	New Registration			1/4/2024 3:43 PM
Terminations	Termination Comments	Insert	New Registration			1/4/2024 3:43 PM
Terminations	Termination Date	Insert	New Registration			1/4/2024 3:43 PM
Terminations	Termination Effective Date	Insert	New Registration			1/4/2024 3:43 PM
Terminations	Termination Reason	Insert	New Registration			1/4/2024 3:43 PM