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DSH450848H Memorial Hermann Sugar Land Hospital (Terminated)
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Main Details
Name
Memorial Hermann Sugar Land Hospital
Subdivision Name
RBJ- Richmond MRI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450848H
Medicare Provider Number
450848
Outpatient Facility Provider Number
450848
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/8/2014
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
7/1/2020
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
1517 Thompson Road
Richmond, TX 77469
Billing Address
Memorial Hermann
929 Gessner Rd, Suite 2690
Houston, TX 77024
Comments
Medicaid Billing
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Contract Pharmacies
Parent/Child
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