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DSH450184BU MEMORIAL HERMANN HOSPITAL SYSTEM (Terminated)
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Main Details
Name
MEMORIAL HERMANN HOSPITAL SYSTEM
Subdivision Name
OPID-Radiology Diagnostic - Clear Lake
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450184BU
Medicare Provider Number
450184
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/5/2015
Last Recertification Date
8/26/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Memorial Hermann System
Rebecca Tucker, VP, Finance
(713) 456-5340
Primary Contact
Memorial Hermann System
Jo Ann Maack, System Pharmacy Director
(713) 242-2814
Addresses
Street Address
16915 El Camino Real
Webster, TX 77058
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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