340B Drug Pricing Program Database
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DSH450018GN UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB CLC Infusion
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018GN
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/5/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/20/2022
Last Recertification Date
9/7/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
UTMB
Carolanda B Woodgett, Senior Vice President and Chief Legal Officer
(409) 747-8735
Primary Contact
UTMB
Sharon Chapman, Director of Operations
(409) 747-3509
Addresses
Street Address
250 Blossom Street
Suite 130
Webster, TX 77598
Billing Address
UTMB
301 University Blvd
Route 0510
Galveston, TX 77555
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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