Covered Entity Details

DSH100009D UNIVERSITY OF MIAMI HOSPITAL (Terminated) - information as of 6/21/2025 12:07:15 AM

Main Details

Name

UNIVERSITY OF MIAMI HOSPITAL

Subdivision Name

Ambulatory Surgery - UMH South

Type

Disproportionate Share Hospital

Rural

340B ID

DSH100009D

Medicare Provider Number

100009

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/13/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/6/2015

Last Recertification Date

9/1/2016

Termination Date
Termination Reason

1/1/2018
Loss of qualifying hospital status

Contacts

Authorizing Official

University of Miami Hospital & Clinics
Michael Gittelman, CEO
(305) 326-6111

Primary Contact

University of Miami Hospital and Clinics
Blanca Rivera, Associate Vice President, UHealth Pharmacy Services
(305) 689-5630

Addresses

Street Address

1295 NW 14th St
Suite A
Miami, FL 33136

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
FL	100366
		1396946208

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH100009A	Child	DSH	University of Miami Hospital	UMH: Sports Medicine - Plantation	8100 SW 10th St, Suite 1400, Sports Medicine	Plantation	FL	Terminated
DSH100009B	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	Physical Therapy - UMH West	1321 NW 14th St.	Miami	FL	Terminated
DSH100009C	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	Cardiology - UMH South	1295 NW 14th St	Miami	FL	Terminated
DSH100009D	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	Ambulatory Surgery - UMH South	1295 NW 14th St	Miami	FL	Terminated
DSH100009E	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	Occupational Therapy - UMH West	1321 NW 14th St	MI	FL	Terminated
DSH100009F	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	GI Center - UMH South	1295 NW 14th St	Miami	FL	Terminated
DSH100009G	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	Physical Therapy - Kendall	8980 SW 97th Avenue	Miami	FL	Terminated
DSH100009H	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	Sports Medicine - UMH West	1321 NW 14th St.	Miami	FL	Terminated
DSH100009J	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	Physical Therapy - Marlins	501 Marlins Way	Miami	FL	Terminated
DSH100009K	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	UMH: Cardiac Rehabilitation - UMH West	1321 NW 14th St.	Miami	FL	Terminated
DSH100009L	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	Physical Therapy - Plantation	8100 SW 10th St.	Plantation	FL	Terminated
DSH100009M	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	MSCC - UMH West	1321 NW 14th St.	Miami	FL	Terminated
DSH100009N	Child	DSH	UNIVERSITY OF MIAMI HOSPITAL	USBC - Spine and Brain Clinic - UMH West	1321 NW 14th St.	Miami	FL	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Rivera, Blanca Executive Director of Pharmacy University of Miami Hospital and Clinics 3056895630	Rivera, Blanca Associate Vice President, UHealth Pharmacy Services University of Miami Hospital and Clinics 3056895630	8/23/2023 11:09 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		10/28/2017 12:00:00 AM	11/3/2017 11:47 AM
Details	State	Update	Recertification	Active	To Be Terminated	11/3/2017 11:47 AM
Terminations	Termination Date	Update	Recertification		1/1/2018 12:00:00 AM	11/3/2017 11:47 AM
Terminations	Termination Effective Date	Update	Recertification		10/29/2017 12:00:00 AM	11/3/2017 11:47 AM
Terminations	Termination Reason	Update	Recertification		Loss of qualifying hospital status	11/3/2017 11:47 AM
Contacts	Primary Contact	Update		Rivera, Blanca Executive Director of Pharmacy 3056895630	Rivera, Blanca Executive Director of Pharmacy University of Miami Hospital and Clinics 3056895630	10/16/2017 5:33 PM
Contacts	Authorizing Official	Update		Gittelman, Michael CEO 3053266111	Gittelman, Michael CEO University of Miami Hospital & Clinics 3053266111	9/29/2017 11:15 AM
Contacts	Authorizing Official	Insert			Gittelman, Michael CEO 3053266111	8/11/2017 10:04 AM
Contacts	Primary Contact	Insert			Rivera, Blanca Executive Director of Pharmacy 3056895630	8/11/2017 10:04 AM
Contacts	Signed By	Insert			Zambrana, David Chief Executive Officer 3056894515	8/10/2017 1:43 PM
Addresses	Main Address	Insert			1295 NW 14th St Suite A Miami, FL 33136	9/1/2016 10:00 AM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	9/1/2016 12:00:00 AM	9/1/2016 10:00 AM
Details	Last Recertification Date	Update			8/17/2015 12:00:00 AM	8/17/2015 4:04 PM
Dates	Participating Approval Date	Update			3/6/2015 12:00:00 AM	3/6/2015 1:52 PM
Details	State	Update		Pending	Active	3/6/2015 1:52 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/6/2015 1:52 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_49006	DSH100009D	2/2/2015 9:42 AM
Details	Entity Subname	Update		UMH: Ambulatory Surgery - UMH South	Ambulatory Surgery - UMH South	2/2/2015 9:42 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_49006	1/13/2015 5:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/13/2015 5:54 PM
Medicaid Billing	Medicaid: Number	Insert			100366	1/13/2015 5:54 PM
Medicaid Billing	Medicaid: State	Insert			FL	1/13/2015 5:54 PM
Medicaid Billing	NPI: Number	Insert			1396946208	1/13/2015 5:54 PM
Details	Last Recertification Date	Insert				1/13/2015 5:54 PM
Details	Grant Number	Insert				1/13/2015 5:54 PM
Details	340B ID	Insert				1/13/2015 5:54 PM
Details	Is Authorizing Official EHB Data	Insert				1/13/2015 5:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/13/2015 5:54 PM
Details	Medicare Provider Number	Insert			100009	1/13/2015 5:54 PM
Details	Entity Name	Insert			UNIVERSITY OF MIAMI HOSPITAL	1/13/2015 5:54 PM
Details	Program Code	Insert			DSH	1/13/2015 5:54 PM
Details	Entity Subname	Insert			UMH: Ambulatory Surgery - UMH South	1/13/2015 5:54 PM
Dates	Participating Approval Date	Insert				1/13/2015 5:54 PM
Details	State	Insert			Pending	1/13/2015 5:54 PM
Dates	Registration Date	Insert			1/13/2015 12:00:00 AM	1/13/2015 5:54 PM
Dates	Signed By Date	Insert			1/13/2015 12:00:00 AM	1/13/2015 5:54 PM
Dates	Start Date	Insert				1/13/2015 5:54 PM
Terminations	Termination Comments	Insert				1/13/2015 5:54 PM
Terminations	Termination Date	Insert				1/13/2015 5:54 PM
Terminations	Termination Effective Date	Insert				1/13/2015 5:54 PM
Terminations	Termination Reason	Insert				1/13/2015 5:54 PM