340B Drug Pricing Program Database
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Central Admixture Pharmacy Services, Inc.
DSH450684 MEMORIAL HERMANN NORTHEAST HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL HERMANN NORTHEAST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450684
Entity Address
18951 N. Memorial Drive
Humble, TX 77338
Medicare Provider Number
450684
Participating Start Date
9/9/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
Central Admixture Pharmacy Services, Inc.
Pharmacy Address
1000 S. Loop West, Ste 115
Houston, TX 77054
Pharmacy Comments
07/26/2013: Pharmacy address corrected, changed in error on 3/28/2013, see history for details.
Contract Details
Approval Date
1/5/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rebecca Tucker, VP, Finance
(713) 456-5340
Contract Pharmacy Representative
Mike Koch, Vice President
(949) 660-2701
Signed By Date
1/5/2015
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