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DSH450213AD UNIVERSITY HEALTH SYSTEM (Terminated)
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Main Details
Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
Ophthalmology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450213AD
Medicare Provider Number
450213
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/30/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/14/2012
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
University Health System
Reed Hurley, Executive Vice President/CFO
(210) 358-2101 Ext: 2141
Primary Contact
Mark Richerson, Director of Pharmacy
(210) 358-2896
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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