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DSH450213AK UNIVERSITY HEALTH SYSTEM (Terminated)
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Main Details
Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
Adult Diabetes Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450213AK
Medicare Provider Number
450213
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/24/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/20/2018
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
University Health System
Reed Hurley, Executive Vice President/CFO
(210) 358-2101 Ext: 2141
Primary Contact
University Health System
Josefa Benedetti, Executive Director of Pharmacy
(210) 743-4077
Addresses
Street Address
701 South Zarzamora
San Antonio, TX 78207
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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initial start date 10/1/2012, termination 10/1/2013, reinstate 4/1/2018
01/26/2018
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