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DSH450018BF UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB NACOGDOCHES RMCHP
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018BF
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
6/9/2009
Participating Start Date
7/1/2009
Participating Approval Date
6/14/2009
Last Recertification Date
8/22/2014
Termination Date
Termination Reason
7/1/2015
Site closure
Contacts
Authorizing Official
UTMB
Carolee A. King, Senior Vice President & General Counsel
(409) 772-1904
Primary Contact
Sharon Metyko, Senior Clinical Staff Pharmacist
(409) 747-4929
Addresses
Street Address
206 MIMS PLAZA
NACOGDOCHES, TX 75961
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/23/12 ADDED NPI#
06/09/2009
April 2025
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