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DSH450018AS UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB MAINLAND CARDIOLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018AS
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/13/2009
Participating Start Date
4/1/2009
Participating Approval Date
3/13/2009
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
UTMB
Carolanda B Woodgett, Senior Vice President and Chief Legal Officer
(409) 747-8735
Primary Contact
UTMB
Sharon Chapman, Director of Operations
(409) 747-3509
Addresses
Street Address
10121 EMMETT F LOWRY EXPRESSWAY
TEXAS CITY, TX 77591-2286
Billing Address
UTMB
301 UNIVERSITY BLVD
Route 0510
GALVESTON, TX 77555-0510
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/30/09 UPDATED ADDR (WAS 6807 EMMETT F. LOWRY EXPY SUITE 310)
04/30/2009
3/23/12 ADDED NPI#; 4/30/09 UPDATED ADDR (WAS 6807 EMMETT F. LOWRY EXPY SUITE 310)
03/13/2009
April 2025
April 2025
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