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DSH450068T MEMORIAL HERMANN TEXAS MEDICAL CNTR (Terminated)
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Main Details
Name
MEMORIAL HERMANN TEXAS MEDICAL CNTR
Subdivision Name
MH Outpatient Imaging - Upper Kirby / Mammography
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068T
Medicare Provider Number
450068
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
Last Recertification Date
9/5/2016
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Memorial Hermann TMC
Bryan Lee, VP, Finance
(713) 704-4710
Primary Contact
Memorial Hermann System
Jo Ann Maack, System Pharmacy Director
(713) 242-2814
Addresses
Street Address
2900 Richmond Ave.
suite 101
Houston, TX 77098
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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