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DSH450024A UNIVERSITY MEDICAL CENTER OF EL PASO (Active)
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Main Details
Name
UNIVERSITY MEDICAL CENTER OF EL PASO
Subdivision Name
UNIVERSITY MEDICAL CENTER - NORTHEAST
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450024A
Medicare Provider Number
450024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/21/2007
Participating Start Date
7/1/1999
Participating Approval Date
11/21/2007
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
University Medical Center of El Paso
MICHAEL NUNEZ, CFO
(915) 521-7626
Primary Contact
UNIVERSITY MEDICAL CENTER OF EL PASO
DAVID CHAN, Asst Administrator Pharmacy Services
(915) 521-7662
Addresses
Street Address
9839 KENWORTHY ST
EL PASO, TX 79924
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/11/12 UPDATED SUBDIV NAME (WAS UNIVERSITY MEDICAL CENTER NORTHEAST PHARMACY), ADDED SHIP ADD, ADDED NPI#; 7/23/09 UPDATED ENTITY NAME AND ADDRESS (WAS R E THOMASON HOSPITAL, THOMASON PHARMACY NORTHEAST, 9849 KENWORTHY)
04/11/2012
7/23/09 UPDATED ENTITY NAME AND ADDRESS (WAS R E THOMASON HOSPITAL, THOMASON PHARMACY NORTHEAST, 9849 KENWORTHY)
07/23/2009
April 2025
April 2025
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