340B Drug Pricing Program Database
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DSH450388BJ METHODIST HOSPITAL (Active)
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Main Details
Name
METHODIST HOSPITAL
Subdivision Name
34392 Methodist Hospital Metropolitan - Phase 2 Recovery - Recovery Room
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450388BJ
Medicare Provider Number
450388
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/28/2024
Last Recertification Date
Contacts
Authorizing Official
Methodist Healthcare
Enrique Bernal, DCFO
(210) 575-0235
Primary Contact
Methodist Healthcare
Jeffrey Brian Mandel, VP of Pharmacy Services
(210) 954-7525
Addresses
Street Address
1310 McCullough Ave
San Antonio, TX 78212
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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