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DSH450018CH UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB CENTER FOR OBESITY AND METABOLIC SURGERY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018CH
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
9/7/2018
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
UTMB
Carolee A. King, Senior Vice President & General Counsel
(409) 772-1904
Primary Contact
UTMB
Sharon Chapman, Director of Operations
(409) 747-3509
Addresses
Street Address
2660 GULF FREEWAY SOUTH
SUITE 3
LEAGUE CITY, TX 77573
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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