340B Drug Pricing Program Database
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DSH450684Q MEMORIAL HERMANN NORTHEAST HOSPITAL (Terminated)
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Main Details
Name
MEMORIAL HERMANN NORTHEAST HOSPITAL
Subdivision Name
Nimetz Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450684Q
Medicare Provider Number
450684
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
8/3/2017
Last Recertification Date
8/19/2024
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
2003 W. W. Thorne Drive, #TM-01
Houston, TX 77073
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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April 2025
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