340B Drug Pricing Program Database
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DSH450068CD Memorial Hermann Texas Medical Center (Terminated)
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Main Details
Name
Memorial Hermann Texas Medical Center
Subdivision Name
Center for Advanced Heart Failure- the Woodlands - cardiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450068CD
Medicare Provider Number
450068
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/28/2020
Last Recertification Date
8/22/2023
Termination Date
Termination Reason
1/1/2024
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
1120 Medical Plaza Drive #150
Shenandoah, TX 77380
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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