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DSH450018CF UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB VL PELVIC HEALTH & CONTINENCE CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018CF
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
11/29/2017
Termination Date
Termination Reason
4/1/2018
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
2240 GULF FREEWAY SOUTH
SUITE 2.100
LEAGUE CITY, TX 77573
Billing Address
UTMB SPECIALTY CARE CENTER AT VICTORY LAKES
2240 GULF FREEWAY SOUTH
Suite 2.203
LEAGUE CITY, TX 77573
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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