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DSH450213BH UNIVERSITY HEALTH SYSTEM (Terminated)
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Main Details
Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
BEXAR COUNTY HOSPITAL DISTRICT - Oral Surgery Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450213BH
Medicare Provider Number
450213
Outpatient Facility Provider Number
450213
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/3/2014
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
903 WEST MARTIN
SAN ANTONIO, TX 78207
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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