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DSH450184DR MEMORIAL HERMANN HOSPITAL SYSTEM (Active)
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Main Details
Name
MEMORIAL HERMANN HOSPITAL SYSTEM
Subdivision Name
Memorial Hermann Greater Heights Hospital - MRI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450184DR
Medicare Provider Number
450184
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/5/2018
Participating Start Date
2/8/2018
Participating Approval Date
2/7/2018
Last Recertification Date
9/3/2024
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
1635 North Loop West
Houston, TX 77008
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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