340B Drug Pricing Program Database
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DSH450068M Memorial Hermann Texas Medical Center (Terminated)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
Lamar Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068M
Medicare Provider Number
450068
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2014
Participating Start Date
4/1/2014
Participating Approval Date
3/12/2014
Last Recertification Date
8/29/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
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
1002 E. Stadium Drive
Rosenberg, TX 77471
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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