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DSH450184AZ MEMORIAL HERMANN HOSPITAL SYSTEM (Terminated)
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Main Details
Name
MEMORIAL HERMANN HOSPITAL SYSTEM
Subdivision Name
Southeast-Mammography (Friendswood)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450184AZ
Medicare Provider Number
450184
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/5/2018
Participating Start Date
2/8/2018
Participating Approval Date
2/7/2018
Last Recertification Date
9/12/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Memorial Hermann System
Rebecca Tucker, VP, Finance
(713) 456-5340
Primary Contact
Memorial Hermann
Illiana Rangel, 340B Manager
(713) 242-2858
Addresses
Street Address
1505 E. Winding Way, #100
Friendswood, TX 77546
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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