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HEB PHARMACY #699
DSH450213 UNIVERSITY HEALTH SYSTEM
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Covered Entity Details
Entity Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
UNIVERSITY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH450213
Entity Address
4502 MEDICAL DRIVE
SAN ANTONIO, TX 78229
Medicare Provider Number
450213
Participating Start Date
10/1/1993
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HEB PHARMACY #699
Pharmacy Address
1601 NOGALITOS ST.
SAN ANTONIO, TX 78204
Pharmacy Comments
Contract Details
Approval Date
7/8/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/8/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Reed Hurley, Executive Vice President/CFO
(210) 358-2101 Ext: 2141
Contract Pharmacy Representative
HEB Pharmacy
Jay Beuche, Manager Contracting
(210) 938-8578
Signed By Date
7/8/2019
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