340B Drug Pricing Program Database
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DSH450018KG UNIVERSITY OF TEXAS MEDICAL BRANCH (Active)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
Hobby Unit - Medical (HB) - CMC TDCJ
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018KG
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/4/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/15/2024
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
UTMB
Carolanda B Woodgett, Senior Vice President and Chief Legal Officer
(409) 747-8735
Primary Contact
University Of Texas Medical Branch
Sarah Renee Reynolds, UTMB 340B Program Analyst
(936) 222-7312
Addresses
Street Address
742 FM 712
Marlin, TX 76661
Billing Address
UTMB-CMC Department of Pharmacy
2400 Avenue I
Huntsville, TX 77340
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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