340B Drug Pricing Program Database
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DSH450184DF MEMORIAL HERMANN HOSPITAL SYSTEM (Terminated)
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Main Details
Name
MEMORIAL HERMANN HOSPITAL SYSTEM
Subdivision Name
Sharpstown Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450184DF
Medicare Provider Number
450184
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/6/2018
Participating Start Date
2/8/2018
Participating Approval Date
2/7/2018
Last Recertification Date
9/5/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Memorial Hermann
Robert C Ogden, Associate Vice President of Finance
(713) 456-5111
Primary Contact
Memorial Hermann
Eric John Wucki, Director of Pharmacy-340B
(262) 527-2475
Addresses
Street Address
7504 Bissonnet Street, Building T9
Houston, TX 77074
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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