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DSH450213NV UNIVERSITY HEALTH SYSTEM (Terminated)
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Main Details
Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
Edgewood Pediatric Development - Developmental and Behavioral Pediatrics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450213NV
Medicare Provider Number
450213
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/14/2024
Last Recertification Date
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
University Health System
Reed Hurley, Executive Vice President/CFO
(210) 358-2101 Ext: 2141
Primary Contact
University Health System
Josefa Benedetti, Executive Director of Pharmacy
(210) 743-4077
Addresses
Street Address
911 Enrique M Barrera
San Antonio, TX 78237
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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