340B Drug Pricing Program Database
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DSH450844B METHODIST WILLOWBROOK HOSPITAL (Terminated)
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Main Details
Name
METHODIST WILLOWBROOK HOSPITAL
Subdivision Name
HMWB Wound Care Program - Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450844B
Medicare Provider Number
450844
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/2/2018
Last Recertification Date
8/23/2018
Termination Date
Termination Reason
1/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Houston Methodist Willowbrook
Makiltru L Fontenette, ACNO
(281) 757-0976
Primary Contact
Houston Methodist
Daniel Metzen, System Director of Pharmacy
(713) 441-2141
Addresses
Street Address
13300 Hargrave Road
Houston, TX 77070
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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