340B Drug Pricing Program Database
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DSH450184GV MEMORIAL HERMANN HOSPITAL SYSTEM (Active)
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Main Details
Name
MEMORIAL HERMANN HOSPITAL SYSTEM
Subdivision Name
The Woodlands - Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450184GV
Medicare Provider Number
450184
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/5/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/14/2022
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Memorial Hermann
Robert C Ogden, Associate Vice President of Finance
(713) 456-5111
Primary Contact
Memorial Hermann
Eric John Wucki, Director of Pharmacy-340B
(262) 527-2475
Addresses
Street Address
920 Medical Plaza Dr.
The Woodlands, TX 77380
Billing Address
Memorial Hermann
929 Gessner Dr
Houston, TX 77024
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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