340B Drug Pricing Program Database
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DSH450610G MEMORIAL HERMANN MEMORIAL CITY MEDIC (Terminated)
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Main Details
Name
MEMORIAL HERMANN MEMORIAL CITY MEDIC
Subdivision Name
Memorial Hermann Memorial City Medical Center - Sleep Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450610G
Medicare Provider Number
450610
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2023
Participating Start Date
7/1/2023
Participating Approval Date
5/22/2023
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
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
929 Gessner Dr.
Houston, TX 77024
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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