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DSH450021F BAYLOR UNIVERSITY MEDICAL CTR (Approved)
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Main Details
Name
BAYLOR UNIVERSITY MEDICAL CTR
Subdivision Name
Apheresis Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450021F
Medicare Provider Number
450021
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/7/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/17/2025
Last Recertification Date
Contacts
Authorizing Official
Baylor University Medical Center
Kyle Armstrong, President
(214) 820-3101
Primary Contact
Baylor University Medical Center
Dana Radman, Director of Pharmacy
(214) 820-2968
Addresses
Street Address
3535 Worth St.
Suite 1030
Dallas, TX 75246
Billing Address
BAYLOR UNIVERSITY MEDICAL CENTER
3500 GASTON AVE
Dallas, TX 75246
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2014, terminated 4/1/2017. Reinstated 7/1/2025.
04/15/2025
April 2025
April 2025
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