340B Drug Pricing Program Database
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DSH450848S Memorial Hermann Sugar Land Hospital (Terminated)
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Main Details
Name
Memorial Hermann Sugar Land Hospital
Subdivision Name
Sienna Outpatient Mammography
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450848S
Medicare Provider Number
450848
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/4/2016
Last Recertification Date
8/30/2021
Termination Date
Termination Reason
10/1/2022
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
8780 Highway 6, Suite B
Missouri City, TX 77459
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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