340B Drug Pricing Program Database
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DSH450068AJ Memorial Hermann Texas Medical Center (Terminated)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
Memorial Hermann Rockets Orthopedic Hospital - Day Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068AJ
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
8/22/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Memorial Hermann Health System
Jessica Ann Graham, Chief Financial Officer
(843) 408-6835
Primary Contact
Memorial Hermann
Eric John Wucki, Director of Pharmacy-340B
(262) 527-2475
Addresses
Street Address
5410 West Loop South
Bellaire, TX 77401
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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