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MEMORIAL HERMANN PHARMACY SERVICES
DSH450184 MEMORIAL HERMANN HOSPITAL SYSTEM
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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
MEMORIAL HERMANN PHARMACY SERVICES
Pharmacy Address
21501 PARK ROW DR
SUITE 200
KATY, TX 77449
Pharmacy Comments
Contract Details
Approval Date
4/2/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rebecca Tucker, VP, Finance
(713) 456-5340
Contract Pharmacy Representative
Memorial Hermann
Joseph Rogers, Pharmacy Director
(281) 698-6150
Signed By Date
4/2/2018
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