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DSH450213BY UNIVERSITY HEALTH SYSTEM (Terminated)
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Main Details
Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
NW Clinic MHCM
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450213BY
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
8/23/2021
Termination Date
Termination Reason
1/1/2022
Site closure
Contacts
Authorizing Official
University Health System
Reed Hurley, Executive Vice President/CFO
(210) 358-2101 Ext: 2141
Primary Contact
University Health System
Josefa Benedetti, Executive Director of Pharmacy
(210) 743-4077
Addresses
Street Address
7726 Louis Pasteur
San Antonio, TX 78229
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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