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DSH450684 MEMORIAL HERMANN NORTHEAST HOSPITAL (Active)
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Main Details
Name
MEMORIAL HERMANN NORTHEAST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450684
Medicare Provider Number
450684
Additional Details
Current Program Status
Active
Registration Date
10/1/2005
Participating Start Date
9/9/2005
Participating Approval Date
8/8/2005
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Memorial Hermann
Robert C Ogden, Associate Vice President of Finance
(713) 456-5111
Primary Contact
Memorial Hermann
Eric John Wucki, Director of Pharmacy-340B
(262) 527-2475
Addresses
Street Address
18951 N. Memorial Drive
Humble, TX 77338
Billing Address
Memorial Hermann
929 Gessner Rd, Suite 2690
Houston, TX 77024
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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