Covered Entity Details

DSH670077A HOUSTON METHODIST WEST HOSPITAL (Active) - information as of 4/29/2025 11:59:45 PM

Main Details

Name

HOUSTON METHODIST WEST HOSPITAL

Subdivision Name

Houston Methodist Emergency Care CE

Type

Disproportionate Share Hospital

Rural

340B ID

DSH670077A

Medicare Provider Number

670077

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/8/2022

Participating Start Date

10/1/2022

Participating Approval Date

8/30/2022

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Houston Methodist West Hospital
Kyle R Stanzel, VP & Chief Operating Officer
(832) 522-0300

Primary Contact

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

Addresses

Street Address

26000 FM 1093 RD
Richmond, TX 77406-7857

Billing Address

Houston Methodist West Hospital
18500 Katy FWY
Houston, TX 77094-1110

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating starting 4/1/2018; Terminated on 10/1/2018; Reinstated 10/1/2022.	08/24/2022

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		1083937593

Shipping Addresses

Shipping Address 1

Houston Methodist West Hospital
18500 Katy FWY
Houston, TX 77094-1110

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
DSH670077A	Child	DSH	HOUSTON METHODIST WEST HOSPITAL	Houston Methodist Emergency Care CE	26000 FM 1093 RD	Richmond	TX	Active
DSH670077B	Child	DSH	HOUSTON METHODIST WEST HOSPITAL	HOUSTON METHODIST NEAL CANCER CENTER	18400 KATY FWY	HOUSTON	TX	Active
DSH670077C	Child	DSH	HOUSTON METHODIST WEST HOSPITAL	HOUSTON METHODIST WEST BREAST CENTE - Breast Center-Radiology Diagnostic	18300 KATY FWY	HOUSTON	TX	Active
DSH670077D	Child	DSH	HOUSTON METHODIST WEST HOSPITAL	Houston Methodist ECC at Cinco Ranch Radiology - Radiology	26000 FM 1093 RD	Richmond	TX	Active
DSH670077E	Child	DSH	HOUSTON METHODIST WEST HOSPITAL	Infusion Center - Infusion Center	18400 Katy Fwy, Suite 200	Houston	TX	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/14/2023 11:33:59 AM	8/15/2024 10:42:09 AM	8/15/2024 10:42 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	281028501 (TX)		7/11/2024 6:03 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	281028502 (TX)		7/11/2024 6:03 PM
Details	Last Recertification Date	Update	Recertification		8/14/2023 11:33:59 AM	8/14/2023 11:33 AM
Contacts	Authorizing Official	Update	Change Request	Brownewell, Vicki A Vice President / CNO Houston Methodist West 8325220300	Stanzel, Kyle R VP & Chief Operating Officer Houston Methodist West Hospital 8325220300	12/12/2022 7:13 AM
Details	Entity Name	Update	Change Request	METHODIST WEST HOUSTON HOSPITAL	HOUSTON METHODIST WEST HOSPITAL	10/13/2022 7:31 AM
Addresses	Main Address	Update	Change Request	26000 FM 1093 Katy, TX 77494	26000 FM 1093 RD Richmond, TX 77406-7857	10/13/2022 7:30 AM
Addresses	Billing Address	Update	Change Request	Houston Methodist West 18500 Katy Freeway Houston, TX 77094	Houston Methodist West Hospital 18500 Katy FWY Houston, TX 77094-1110	10/13/2022 7:30 AM
Addresses	Shipping Address	Update	Change Request	Houston Methodist West 18500 Katy Freeway Houston, TX 77094	Houston Methodist West Hospital 18500 Katy FWY Houston, TX 77094-1110	10/13/2022 7:30 AM
Details	Entity Subname	Update	Change Request	Houston Methodist Emergency Care Center in Cinco Ranch - Emergency Care	Houston Methodist Emergency Care CE	10/13/2022 7:30 AM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Addresses	Billing Address	Insert	Reinstatement		Houston Methodist West 18500 Katy Freeway Houston, TX 77094	8/30/2022 9:46 AM
Addresses	Shipping Address	Insert	Reinstatement		Houston Methodist West 18500 Katy Freeway Houston, TX 77094	8/30/2022 9:46 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Reinstatement		False	8/30/2022 9:46 AM
Medicaid Billing	Medicaid: Number	Insert	Reinstatement		281028501	8/30/2022 9:46 AM
Medicaid Billing	Medicaid: State	Insert	Reinstatement		TX	8/30/2022 9:46 AM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1083937593	8/30/2022 9:46 AM
Medicaid Billing	NPI: State	Insert	Reinstatement		TX	8/30/2022 9:46 AM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1083937593 ( )		8/30/2022 9:46 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	5/31/2018 12:00:00 AM		8/30/2022 9:46 AM
Dates	Participating Approval Date	Update	Reinstatement	1/24/2018 8:56:07 AM	8/30/2022 9:46:09 AM	8/30/2022 9:46 AM
Details	State	Update	Reinstatement	Terminated	Approved	8/30/2022 9:46 AM
Dates	Registration Date	Update	Reinstatement	1/12/2018 10:48:17 AM	7/8/2022 10:46:51 AM	8/30/2022 9:46 AM
Dates	Signed By Date	Update	Reinstatement	1/12/2018 5:34:04 PM	7/12/2022 11:43:27 AM	8/30/2022 9:46 AM
Dates	Start Date	Update	Reinstatement	4/1/2018 12:00:00 AM	10/1/2022 12:00:00 AM	8/30/2022 9:46 AM
Terminations	Termination Comments	Update	Reinstatement	5/31/2018 filed cost report shows DSH% at 11.13		8/30/2022 9:46 AM
Terminations	Termination Date	Update	Reinstatement	10/1/2018 12:00:00 AM		8/30/2022 9:46 AM
Terminations	Termination Effective Date	Update	Reinstatement	5/31/2018 12:00:00 AM		8/30/2022 9:46 AM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		8/30/2022 9:46 AM
Details	Comments Public	Insert	Reinstatement		Participating starting 4/1/2018; Terminated on 10/1/2018; Reinstated 10/1/2022.	8/24/2022 10:31 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2018 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/31/2018 12:00:00 AM	7/12/2018 1:38 PM
Details	State	Update	Termination Request	Active	To Be Terminated	7/12/2018 1:38 PM
Terminations	Termination Comments	Update	Termination Request		5/31/2018 filed cost report shows DSH% at 11.13	7/12/2018 1:38 PM
Terminations	Termination Date	Update	Termination Request		10/1/2018 12:00:00 AM	7/12/2018 1:38 PM
Terminations	Termination Effective Date	Update	Termination Request		5/31/2018 12:00:00 AM	7/12/2018 1:38 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	7/12/2018 1:38 PM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Brownewell, Vicki A Vice President / CNO Houston Methodist West 8325220300	1/24/2018 8:56 AM
Details	340B ID	Update	New Registration		DSH670077A	1/24/2018 8:56 AM
Details	Entity Subname	Update	New Registration	Houston Methodist Emergency Care Center in Cinco Ranch	Houston Methodist Emergency Care Center in Cinco Ranch - Emergency Care	1/24/2018 8:56 AM
Dates	Participating Approval Date	Update	New Registration		1/24/2018 8:56:07 AM	1/24/2018 8:56 AM
Details	State	Update	New Registration	Pending	Approved	1/24/2018 8:56 AM
Dates	Signed By Date	Update	New Registration		1/12/2018 5:34:04 PM	1/24/2018 8:56 AM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/24/2018 8:56 AM
Addresses	Main Address	Insert	New Registration		26000 FM 1093 Katy, TX 77494	1/12/2018 10:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2018 10:48 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		281028502	1/12/2018 10:48 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		TX	1/12/2018 10:48 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1083937593	1/12/2018 10:48 AM
Contacts	Authorizing Official	Insert	New Registration		Brownewell, Vicki A Vice President / CNO Houston Methodist West 8325220300	1/12/2018 10:48 AM
Contacts	Primary Contact	Insert	New Registration		Metzen, Daniel System Director of Pharmacy Houston Methodist 7134412141	1/12/2018 10:48 AM
Details	Last Recertification Date	Insert	New Registration			1/12/2018 10:48 AM
Details	Grant Number	Insert	New Registration			1/12/2018 10:48 AM
Details	340B ID	Insert	New Registration			1/12/2018 10:48 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2018 10:48 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2018 10:48 AM
Details	Medicare Provider Number	Insert	New Registration		670077	1/12/2018 10:48 AM
Details	Entity Name	Insert	New Registration		METHODIST WEST HOUSTON HOSPITAL	1/12/2018 10:48 AM
Details	Program Code	Insert	New Registration		DSH	1/12/2018 10:48 AM
Details	Entity Subname	Insert	New Registration		Houston Methodist Emergency Care Center in Cinco Ranch	1/12/2018 10:48 AM
Dates	Participating Approval Date	Insert	New Registration			1/12/2018 10:48 AM
Details	State	Insert	New Registration		Pending	1/12/2018 10:48 AM
Dates	Registration Date	Insert	New Registration		1/12/2018 10:48:17 AM	1/12/2018 10:48 AM
Dates	Signed By Date	Insert	New Registration			1/12/2018 10:48 AM
Dates	Start Date	Insert	New Registration			1/12/2018 10:48 AM
Terminations	Termination Comments	Insert	New Registration			1/12/2018 10:48 AM
Terminations	Termination Date	Insert	New Registration			1/12/2018 10:48 AM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2018 10:48 AM
Terminations	Termination Reason	Insert	New Registration			1/12/2018 10:48 AM