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DSH450184DJ MEMORIAL HERMANN HOSPITAL SYSTEM (Terminated)
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Main Details
Name
MEMORIAL HERMANN HOSPITAL SYSTEM
Subdivision Name
Southeast - Maternal Fetal Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450184DJ
Medicare Provider Number
450184
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/13/2015
Last Recertification Date
11/21/2017
Termination Date
Termination Reason
2/5/2018
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
11800 Astoria Blvd.
Houston, TX 77089
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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