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DSH450018CQ UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB Pediatric After-Hours Urgent Care South Shore
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018CQ
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/10/2014
Last Recertification Date
9/9/2020
Termination Date
Termination Reason
10/1/2021
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
3023 Marina Bay Drive
Suite 101
League City, TX 77573-2882
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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