340B Drug Pricing Program Database
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DSH450684A MEMORIAL HERMANN NORTHEAST HOSPITAL (Terminated)
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Main Details
Name
MEMORIAL HERMANN NORTHEAST HOSPITAL
Subdivision Name
Burbank Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450684A
Medicare Provider Number
450684
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2013
Participating Start Date
10/1/2013
Participating Approval Date
8/30/2013
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
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
315 Berry Road
Houston, TX 77022
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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