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DSH450018DP UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB HEALTH LEAGUE CITY HOSPITAL / LABOR AND DELIVERY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018DP
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2017
Participating Start Date
7/1/2017
Participating Approval Date
6/8/2017
Last Recertification Date
9/7/2018
Termination Date
Termination Reason
7/1/2019
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
UTMB
Carolee A. King, Senior Vice President & General Counsel
(409) 772-1904
Primary Contact
UTMB & CMC
Shari Doughty Gore, 340B Program Director UTMB & CMC
(870) 904-2219
Addresses
Street Address
2240 GULF FREEWAY SOUTH
LEAGUE CITY, TX 77573-5143
Billing Address
UTMB
301 UNIVERSITY BLVD
GALVESTON, TX 77555-0401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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