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DSH450068 Memorial Hermann Texas Medical Center (Active)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
Memorial Hermann Texas Medical Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068
Medicare Provider Number
450068
Additional Details
Current Program Status
Active
Registration Date
10/30/2007
Participating Start Date
4/1/1994
Participating Approval Date
10/30/2007
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Memorial Hermann Texas Medical Center
Matt Pruitt, CFO
(713) 704-0112
Primary Contact
Memorial Hermann
Eric John Wucki, Director of Pharmacy-340B
(262) 527-2475
Addresses
Street Address
6411 Fannin St.
Houston, TX 77030
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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9/14/13 DSH% UPDATED TO MATCH COST REPORT SUBMITTED IN SUPPORT OF NEW OUTPATIENT SITE REGISTRATIONS. 10/30/07 UPDATED ENTITY NAME (ADDED MEMORIAL)
09/14/2013
10/30/07 UPDATED ENTITY NAME (ADDED MEMORIAL)
01/12/2010
May 2025
May 2025
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