340B Drug Pricing Program Database
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DSH450068CB Memorial Hermann Texas Medical Center (Active)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
Cypress - Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068CB
Medicare Provider Number
450068
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2020
Participating Start Date
7/1/2020
Participating Approval Date
5/8/2020
Last Recertification Date
8/29/2024
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
27800 Northwest Freeway
Cypress, TX 77433
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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