Covered Entity Details

DSH450844J HOUSTON METHODIST WILLOWBROOK HOSPITAL (Active) - information as of 4/23/2025 10:55:38 PM

Main Details

Name

HOUSTON METHODIST WILLOWBROOK HOSPITAL

Subdivision Name

Houston Methodist Emergency Care Center in Magnolia - Magnolia Emergency Center

Type

Disproportionate Share Hospital

Rural

340B ID

DSH450844J

Medicare Provider Number

450844

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/9/2024

Participating Start Date

10/1/2024

Participating Approval Date

9/13/2024

Last Recertification Date

Contacts

Authorizing Official

Houston Methodist Willowbrook Hospital
Julie K Peterson, Vice President/Chief Operating Officer
(281) 737-2115

Primary Contact

Houston Methodist
Daniel Metzen, System Director of Pharmacy
(713) 441-2141

Addresses

Street Address

18230 FM 1488 RD STE 101
Magnolia, TX 77354-4529

Billing Address

Houston Methodist Willowbrook Hospital
18220 State Highway 249
Houston, TX 77070-4347

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
TX		1871619254

Shipping Addresses

Shipping Address 1

Houston Methodist Willowbrook Hospital
18220 State Highway 249
Houston, TX 77070-4347

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH450844A	Child	DSH	HOUSTON METHODIST WILLOWBROOK HOSPITAL	Houston Methodist Emergency Care Center in Cypress	27560 HIGHWAY 290	Cypress	TX	ToBeTerminated
DSH450844B	Child	DSH	METHODIST WILLOWBROOK HOSPITAL	HMWB Wound Care Program - Wound Care	13300 Hargrave Road	Houston	TX	Terminated
DSH450844C	Child	DSH	HOUSTON METHODIST WILLOWBROOK HOSPITAL	Houston Methodist Emergency Care Center in Spring	5303 FM 2920 RD	Spring	TX	Active
DSH450844D	Child	DSH	HOUSTON METHODIST WILLOWBROOK HOSPITAL	HOUSTON METHODIST WILLOWBROOK AMBUL	13802 Centerfield Dr. STE 100	Houston	TX	Active
DSH450844E	Child	DSH	HOUSTON METHODIST WILLOWBROOK HOSPITAL	Houston Methodist Neal Cancer Center at Willowbrook	13802 Centerfield Dr, STE 185	Houston	TX	Active
DSH450844F	Child	DSH	HOUSTON METHODIST WILLOWBROOK HOSPITAL	Houston Methodist ECC in Magnolia - Radiology - Radiology	18230 FM 1488 RD, STE 101	Magnolia	TX	Active
DSH450844G	Child	DSH	HOUSTON METHODIST WILLOWBROOK HOSPITAL	Houston Methodist ECC in Spring - Radiology - Radiology	5303 FM2920 RD	Spring	TX	Active
DSH450844H	Child	DSH	HOUSTON METHODIST WILLOWBROOK HOSPITAL	Houston Methodist ECC in Cypress Radiology - Radiology	27560 Highway 290	Cypress	TX	ToBeTerminated
DSH450844J	Child	DSH	HOUSTON METHODIST WILLOWBROOK HOSPITAL	Houston Methodist Emergency Care Center in Magnolia - Magnolia Emergency Center	18230 FM 1488 RD STE 101	Magnolia	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Peterson, Julie K Vice President/Chief Operating Officer Houston Methodist Willowbrook Hospital 2817372115	9/13/2024 8:58 AM
Details	340B ID	Update	New Registration		DSH450844J	9/13/2024 8:58 AM
Details	Entity Name	Update	New Registration	METHODIST WILLOWBROOK HOSPITAL	HOUSTON METHODIST WILLOWBROOK HOSPITAL	9/13/2024 8:58 AM
Details	Entity Subname	Update	New Registration	Houston Methodist Emergency Care Center in Magnolia	Houston Methodist Emergency Care Center in Magnolia - Magnolia Emergency Center	9/13/2024 8:58 AM
Dates	Participating Approval Date	Update	New Registration		9/13/2024 8:58:00 AM	9/13/2024 8:58 AM
Details	State	Update	New Registration	Pending	Approved	9/13/2024 8:58 AM
Dates	Signed By Date	Update	New Registration		7/10/2024 3:47:31 PM	9/13/2024 8:58 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	9/13/2024 8:58 AM
Addresses	Main Address	Insert	New Registration		18230 FM 1488 RD STE 101 Magnolia, TX 77354-4529	7/9/2024 1:54 PM
Addresses	Billing Address	Insert	New Registration		Houston Methodist Willowbrook Hospital 18220 State Highway 249 Houston, TX 77070-4347	7/9/2024 1:54 PM
Addresses	Shipping Address	Insert	New Registration		Houston Methodist Willowbrook Hospital 18220 State Highway 249 Houston, TX 77070-4347	7/9/2024 1:54 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1871619254	7/9/2024 1:54 PM
Medicaid Billing	NPI: State	Insert	New Registration		TX	7/9/2024 1:54 PM
Contacts	Authorizing Official	Insert	New Registration		Peterson, Julie K Vice President/Chief Operating Officer Houston Methodist Willowbrook Hospital 2817372115	7/9/2024 1:54 PM
Contacts	Primary Contact	Insert	New Registration		Metzen, Daniel System Director of Pharmacy Houston Methodist 7134412141	7/9/2024 1:54 PM
Details	Assistance Received From Date	Insert	New Registration			7/9/2024 1:54 PM
Details	Assistance Received To Date	Insert	New Registration			7/9/2024 1:54 PM
Details	Last Recertification Date	Insert	New Registration			7/9/2024 1:54 PM
Details	Grant Number	Insert	New Registration			7/9/2024 1:54 PM
Details	340B ID	Insert	New Registration			7/9/2024 1:54 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/9/2024 1:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/9/2024 1:54 PM
Details	Medicare Provider Number	Insert	New Registration		450844	7/9/2024 1:54 PM
Details	Entity Name	Insert	New Registration		METHODIST WILLOWBROOK HOSPITAL	7/9/2024 1:54 PM
Details	NOFO Number	Insert	New Registration			7/9/2024 1:54 PM
Details	Program Code	Insert	New Registration		DSH	7/9/2024 1:54 PM
Details	Entity Subname	Insert	New Registration		Houston Methodist Emergency Care Center in Magnolia	7/9/2024 1:54 PM
Dates	Participating Approval Date	Insert	New Registration			7/9/2024 1:54 PM
Details	State	Insert	New Registration		Pending	7/9/2024 1:54 PM
Dates	Registration Date	Insert	New Registration		7/9/2024 1:54:54 PM	7/9/2024 1:54 PM
Dates	Signed By Date	Insert	New Registration			7/9/2024 1:54 PM
Dates	Start Date	Insert	New Registration			7/9/2024 1:54 PM
Terminations	Termination Comments	Insert	New Registration			7/9/2024 1:54 PM
Terminations	Termination Date	Insert	New Registration			7/9/2024 1:54 PM
Terminations	Termination Effective Date	Insert	New Registration			7/9/2024 1:54 PM
Terminations	Termination Reason	Insert	New Registration			7/9/2024 1:54 PM