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DSH450018HD UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
Central Medical Admin - CMC TDCJ
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018HD
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/15/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
Other
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
200 River Pointe
Suite 200
Conroe, TX 77304
Billing Address
UTMB-CMC Department of Pharmacy
2400 Avenue I
Huntsville, TX 77340
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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