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DSH450686C UNIVERSITY MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY MEDICAL CENTER
Subdivision Name
UMC OUTPATIENT GI CENTER - Gastroenterology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450686C
Medicare Provider Number
450686
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/6/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/2/2021
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
University Medical Center
John Lowe, Vice President of Support Services
(806) 775-8516
Primary Contact
University Medical Center
Courtney Armstrong, Director of Pharmacy
(806) 775-9391
Addresses
Street Address
10202 QUAKER AVE
LUBBOCK, TX 79424-8394
Billing Address
University Medical Center
602 Indiana Ave
Lubbock, TX 79415
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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