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DSH450018BB UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB DICKINSON RMCHP
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018BB
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/4/2009
Participating Start Date
7/1/2009
Participating Approval Date
6/14/2009
Last Recertification Date
9/6/2022
Termination Date
Termination Reason
7/1/2023
Site closure
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
3828 Hughes Court
Suite 104
Dickinson, TX 77539
Billing Address
UTMB
301 UNIVERSITY BLVD.
JSA 8.136, RT 0510, ATTN: NATHAN FLOMIN
GALVESTON, TX 77555-0510
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/23/12 ADDED NPI#
06/04/2009
April 2025
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