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DSH450018GP UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB VLTC X-Ray - radiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018GP
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
9/6/2022
Termination Date
Termination Reason
4/1/2023
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
2660 Gulf Freeway South
Entrance B
LEAGUE CITY, TX 77573
Billing Address
UTMB
301 University Blvd
Route 0510
Galveston, TX 77555
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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