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DSH450184DH MEMORIAL HERMANN HOSPITAL SYS (Terminated)
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Main Details
Name
MEMORIAL HERMANN HOSPITAL SYS
Subdivision Name
Pearland Convenient Care Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450184DH
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
8/24/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Memorial Hermann System
Rebecca Tucker, VP, Finance
(713) 456-5340
Primary Contact
Rachel Samuel, Pharmacy Director
(281) 929-4568
Addresses
Street Address
16100 South Freeway
Pearland, TX 77584
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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