340B Drug Pricing Program Database
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DSH450388DP METHODIST HOSPITAL (Active)
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Main Details
Name
METHODIST HOSPITAL
Subdivision Name
27540- Methodist Hospital Landmark- Blood Bank - BLOOD STORING, PROCESSING & TRANS.
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450388DP
Medicare Provider Number
450388
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2025
Participating Start Date
4/1/2025
Participating Approval Date
2/13/2025
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
5510 Presidio Parkway
San Antonio, TX 78249
Billing Address
Methodist Hospital- Landmark
1151 Enterprise Drive
Suite 100
Coppell, TX 75019
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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