340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
RANDALL PHARMACY #3070
DSH450184 MEMORIAL HERMANN HOSPITAL SYSTEM
Print
Covered Entity Details
Entity Name
MEMORIAL HERMANN HOSPITAL SYSTEM
Subdivision Name
Memorial Hermann Southwest Hospital
Type
Disproportionate Share Hospital
340B ID
DSH450184
Entity Address
7600 Beechnut
Houston, TX 77074
Medicare Provider Number
450184
Participating Start Date
2/7/2018
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
RANDALL PHARMACY #3070
Pharmacy Address
1525 S. MASON RD
KATY, TX 77450
Pharmacy Comments
Contract Details
Approval Date
10/20/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/28/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DAVID STRICKLER, CHIEF FINANCIAL OFFICER
(713) 456-5340
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
10/20/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session