340B Drug Pricing Program Database
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DSH450068BT Memorial Hermann Texas Medical Center (Terminated)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
MH Orthopedic and Spine Hospital - Pain Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068BT
Medicare Provider Number
450068
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/31/2018
Last Recertification Date
8/17/2021
Termination Date
Termination Reason
10/1/2022
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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