340B Drug Pricing Program Database
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DSH450068AR Memorial Hermann Texas Medical Center (Terminated)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
Alief Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068AR
Medicare Provider Number
450068
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
8/12/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Memorial Hermann Texas Medical Center
Matt Pruitt, CFO
(713) 704-0112
Primary Contact
Memorial Hermann
Eric John Wucki, Director of Pharmacy-340B
(262) 527-2475
Addresses
Street Address
12360 Bear Ram Road #T-1
Houston, TX 77072
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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