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WALGREEN CO.
DSH450068 Memorial Hermann Texas Medical Center
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Covered Entity Details
Entity Name
Memorial Hermann Texas Medical Center
Subdivision Name
Memorial Hermann Texas Medical Center
Type
Disproportionate Share Hospital
340B ID
DSH450068
Entity Address
6411 Fannin St.
Houston, TX 77030
Medicare Provider Number
450068
Participating Start Date
4/1/1994
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #15277
1415 CALIFORNIA ST
SUITE 100
HOUSTON, TX 77006
Pharmacy Comments
Contract Details
Approval Date
10/16/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/8/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Dean, CFO
(713) 704-5292
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2015
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