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DSH450018 UNIVERSITY OF TEXAS MEDICAL BRANCH (Active)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018
Medicare Provider Number
450018
Additional Details
Current Program Status
Active
Registration Date
11/29/2007
Participating Start Date
4/1/1994
Participating Approval Date
11/29/2007
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
UTMB
Carolanda B Woodgett, Senior Vice President and Chief Legal Officer
(409) 747-8735
Primary Contact
UTMB & CMC
Shari Doughty Gore, 340B Program Director UTMB & CMC
(870) 904-2219
Addresses
Street Address
301 UNIVERSITY BLVD
GALVESTON, TX 77555
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/7/08 MODIF MED # (WAS 250311)
02/07/2008
3/23/12 ADD NPI#; 2/7/08 MODIF MED # (WAS 250311)
11/29/2007
April 2025
April 2025
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