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DSH450068AH MEMORIAL HERMANN TEXAS MEDICAL CNTR (Terminated)
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Main Details
Name
MEMORIAL HERMANN TEXAS MEDICAL CNTR
Subdivision Name
Operating Room
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068AH
Medicare Provider Number
450068
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/10/2016
Last Recertification Date
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Memorial Hermann TMC
Bryan Lee, VP, Finance
(713) 704-4710
Primary Contact
Jim Maddock, Director of Pharmacy
(713) 704-0974
Addresses
Street Address
5410 West Loop South
Bellaire, TX 77401
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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