Details | Entity Name | Update | Change Request | SOUTH MIAMI HOSPITAL | South Miami Hospital | 3/20/2025 8:32 AM |
Details | Last Recertification Date | Update | Recertification | 9/1/2023 3:33:36 PM | 8/28/2024 2:09:13 PM | 8/28/2024 2:09 PM |
Addresses | Billing Address | Update | Change Request | Doral UCC
Baptist Health South Florida Accounts Payable
PO Box 29002
Miami, FL 33102 | Doral UCC
Baptist Health South Florida Accounts Payable
8900 North Kendall Drive
Miami, FL 33176 | 6/17/2024 1:03 PM |
Addresses | Billing Address | Update | Change Request | Doral Ucc - BHSF Accounts Payable
8900 North Kendall Drive
Miami, FL 33176-2197 | Doral UCC
Baptist Health South Florida Accounts Payable
PO Box 29002
Miami, FL 33102 | 2/14/2024 1:17 PM |
Details | Last Recertification Date | Update | Recertification | 9/19/2022 7:41:52 AM | 9/1/2023 3:33:36 PM | 9/1/2023 3:33 PM |
Addresses | Shipping Address | Delete | Change Request | Baptist Health South Florida
Baptist Health Pharmacy Shared Services Center
9001 NW 33rd Street
Doral, FL 33172 | | 2/14/2023 7:03 AM |
Addresses | Shipping Address | Insert | Change Request | | Baptist Health South Florida
Baptist Health Pharmacy Shared Services Center
14408 Commerce Way
Miami Lakes, FL 33016 | 10/24/2022 12:22 PM |
Addresses | Shipping Address | Delete | Recertification | South Miami Hospital
Doral Urgent Care Center
9915 NW 41 Street
Miami, FL 33178 | | 9/19/2022 7:41 AM |
Addresses | Shipping Address | Insert | Recertification | | South Miami Hospital
Doral Urgent Care Center
9915 NW 41 Street
Doral, FL 33178 | 9/19/2022 7:41 AM |
Addresses | Shipping Address | Insert | Recertification | | RedPharm Drug
6501 City West Pkwy
Eden Prairie, MN 55344 | 9/19/2022 7:41 AM |
Addresses | Shipping Address | Insert | Recertification | | EPM Packaging Inc
210 E 4th Street
Lexington, NE 68850 | 9/19/2022 7:41 AM |
Addresses | Main Address | Update | Recertification |
9915 NW 41 Street
Miami, FL 33178 |
9915 NW 41 Street
Doral, FL 33178 | 9/19/2022 7:41 AM |
Details | Last Recertification Date | Update | Recertification | 9/11/2021 2:49:33 PM | 9/19/2022 7:41:52 AM | 9/19/2022 7:41 AM |
Details | Entity Subname | Update | Recertification | Doral UCC | Urgent Care Center - Doral | 9/19/2022 7:41 AM |
Addresses | Shipping Address | Insert | Change Request | | South Miami Hospital
Doral Urgent Care Center
9915 NW 41 Street
Miami, FL 33178 | 6/7/2022 7:07 AM |
Addresses | Shipping Address | Insert | Change Request | | Baptist Health South Florida
Baptist Health Pharmacy Shared Services Center
9001 NW 33rd Street
Doral, FL 33172 | 6/7/2022 7:07 AM |
Details | Last Recertification Date | Update | Recertification | 8/18/2020 6:42:51 PM | 9/11/2021 2:49:33 PM | 9/11/2021 2:49 PM |
Contacts | Authorizing Official | Update | Profile Change Request | Camejo, Madeline
Vice President and Chief Pharmacy Officer
Baptist Health South Florida
7865951130 | Camejo, Madeline
Vice President and Chief Pharmacy Officer
Baptist Health South Florida
7866620801 | 9/10/2021 4:10 PM |
Medicaid Billing | NPI: State | Update | Recertification | | FL | 8/18/2020 6:42 PM |
Details | Last Recertification Date | Update | Recertification | 8/30/2019 9:49:48 AM | 8/18/2020 6:42:51 PM | 8/18/2020 6:42 PM |
Contacts | Primary Contact | Update | Profile Change Request | Marcelin, Halena Leah
Director, Pharmacy Business Affairs
Baptist Health South Florida
7866620785 | Marcelin, Halena Leah
Director, Pharmacy Business Affairs
Baptist Health South Florida
7866620805 | 5/27/2020 8:26 PM |
Details | Last Recertification Date | Update | Recertification | 9/12/2018 1:03:47 PM | 8/30/2019 9:49:48 AM | 8/30/2019 9:49 AM |
Contacts | Primary Contact | Update | Recertification | Rouseff, Maribeth
Assistant VP
Baptist Health South Florida
7865963330 | Marcelin, Halena Leah
Director, Pharmacy Business Affairs
Baptist Health South Florida
7866620785 | 9/12/2018 1:03 PM |
Details | Last Recertification Date | Update | Recertification | 12/6/2017 12:03:59 PM | 9/12/2018 1:03:47 PM | 9/12/2018 1:03 PM |
Contacts | Authorizing Official | Update | AO Change Request | Thomson Quintero, Suzzanne
Chief Procurement Office and Corporate Vice President
Baptist Hospital Of Miami
7866627866 | Camejo, Madeline
Vice President and Chief Pharmacy Officer
Baptist Health South Florida
7865951130 | 8/27/2018 9:46 AM |
Addresses | Main Address | Update | Recertification |
Doral UCC
9915 NW 41 Street
Miami, FL 33178 |
9915 NW 41 Street
Miami, FL 33178 | 12/6/2017 12:03 PM |
Details | Last Recertification Date | Update | Recertification | 8/12/2016 12:00:00 AM | 12/6/2017 12:03:59 PM | 12/6/2017 12:03 PM |
Contacts | Primary Contact | Update | Profile Change Request | Rouseff, Maribeth
Assistant VP
Baptist Hospital of Miami, Inc
7865963330 | Rouseff, Maribeth
Assistant VP
Baptist Health South Florida
7865963330 | 11/21/2017 1:42 PM |
Contacts | Authorizing Official | Update | AO Change Request | MENDEZ, LINCOLN
CEO
7866628848 | Thomson Quintero, Suzzanne
Chief Procurement Office and Corporate Vice President
Baptist Hospital Of Miami
7866627866 | 10/17/2017 12:23 PM |
Contacts | Primary Contact | Update | | Rouseff, Maribeth
Assistant VP
7865963330 | Rouseff, Maribeth
Assistant VP
Baptist Hospital of Miami, Inc
7865963330 | 9/21/2017 10:45 AM |
Contacts | Primary Contact | Insert | | | Rouseff, Maribeth
Assistant VP
7865963330 | 6/12/2017 11:16 AM |
Addresses | Main Address | Insert | | |
Doral UCC
9915 NW 41 Street
Miami, FL 33178 | 8/12/2016 8:23 AM |
Contacts | Authorizing Official | Insert | | | MENDEZ, LINCOLN
CEO
7866628848 | 8/12/2016 8:23 AM |
Contacts | Signed By | Insert | | | MENDEZ, LINCOLN
CEO
7866628848 | 8/12/2016 8:23 AM |
Details | Last Recertification Date | Update | | | 8/12/2016 12:00:00 AM | 8/12/2016 8:23 AM |
Addresses | Billing Address | Insert | | | Doral Ucc - BHSF Accounts Payable
8900 North Kendall Drive
Miami, FL 33176-2197 | 5/13/2016 9:45 AM |
Dates | Participating Approval Date | Update | | | 5/13/2016 12:00:00 AM | 5/13/2016 9:44 AM |
Details | State | Update | | Pending | Active | 5/13/2016 9:44 AM |
Dates | Start Date | Update | | | 7/1/2016 12:00:00 AM | 5/13/2016 9:44 AM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_59997 | DSH100154D | 5/11/2016 2:57 PM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_59997 | 4/13/2016 11:46 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/13/2016 11:46 AM |
Medicaid Billing | Medicaid: Number | Insert | | | 010058700 | 4/13/2016 11:46 AM |
Medicaid Billing | Medicaid: State | Insert | | | FL | 4/13/2016 11:46 AM |
Medicaid Billing | NPI: Number | Insert | | | 1982688230 | 4/13/2016 11:46 AM |
Details | Last Recertification Date | Insert | | | | 4/13/2016 11:46 AM |
Details | Grant Number | Insert | | | | 4/13/2016 11:46 AM |
Details | 340B ID | Insert | | | | 4/13/2016 11:46 AM |
Details | Is Authorizing Official EHB Data | Insert | | | | 4/13/2016 11:46 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/13/2016 11:46 AM |
Details | Medicare Provider Number | Insert | | | 100154 | 4/13/2016 11:46 AM |
Details | Entity Name | Insert | | | SOUTH MIAMI HOSPITAL | 4/13/2016 11:46 AM |
Details | Program Code | Insert | | | DSH | 4/13/2016 11:46 AM |
Details | Entity Subname | Insert | | | Doral UCC | 4/13/2016 11:46 AM |
Dates | Participating Approval Date | Insert | | | | 4/13/2016 11:46 AM |
Details | State | Insert | | | Pending | 4/13/2016 11:46 AM |
Dates | Registration Date | Insert | | | 4/13/2016 12:00:00 AM | 4/13/2016 11:46 AM |
Dates | Signed By Date | Insert | | | 4/13/2016 12:00:00 AM | 4/13/2016 11:46 AM |
Dates | Start Date | Insert | | | | 4/13/2016 11:46 AM |
Terminations | Termination Comments | Insert | | | | 4/13/2016 11:46 AM |
Terminations | Termination Date | Insert | | | | 4/13/2016 11:46 AM |
Terminations | Termination Effective Date | Insert | | | | 4/13/2016 11:46 AM |
Terminations | Termination Reason | Insert | | | | 4/13/2016 11:46 AM |