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DSH450068Y Memorial Hermann Texas Medical Center (Active)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
Acute Heart Failure Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068Y
Medicare Provider Number
450068
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
Last Recertification Date
8/29/2024
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
6400 Fannin
Houston, TX 77030
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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