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DSH450848K Memorial Hermann Sugar Land Hospital (Active)
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Main Details
Name
Memorial Hermann Sugar Land Hospital
Subdivision Name
OPID-Sugar Land Breast Center - Mammography
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450848K
Medicare Provider Number
450848
Outpatient Facility Provider Number
450848
Additional Details
Current Program Status
Active
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/8/2014
Last Recertification Date
8/29/2024
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
17510 West Grand Parkway #120
Sugar Land, TX 77479
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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