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MEMORIAL HERMANN PHARMACY - SUGAR LAND
DSH450848 Memorial Hermann Sugar Land Hospital
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Covered Entity Details
Entity Name
Memorial Hermann Sugar Land Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450848
Entity Address
17500 West Grand Parkway
Sugar Land, TX 77479
Medicare Provider Number
450848
Participating Start Date
1/1/2012
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
MEMORIAL HERMANN PHARMACY - SUGAR LAND
Pharmacy Address
17510 W GRAND PKWY S STE 190
SUGAR LAND, TX 77479-2647
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
4/17/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca Tucker, VP, Finance
(713) 456-5340
Contract Pharmacy Representative
Memorial Hermann Pharmacy Services
Cody Meuth, Director of Pharmacy
(281) 725-5271
Signed By Date
4/15/2020
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