Covered Entity Details

DSH100154T South Miami Hospital (Active) - information as of 6/21/2025 10:41:43 PM

Main Details

Name

South Miami Hospital

Subdivision Name

Pulmonary Rehab

Type

Disproportionate Share Hospital

Rural

340B ID

DSH100154T

Medicare Provider Number

100154

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/15/2019

Participating Start Date

1/1/2020

Participating Approval Date

10/23/2019

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Baptist Health South Florida
Madeline Camejo, Vice President and Chief Pharmacy Officer
(786) 662-0801

Primary Contact

Baptist Health South Florida
Halena Leah Marcelin, Director, Pharmacy Business Affairs
(786) 662-0805

Addresses

Street Address

6250 Sunset Drive
South Miami, FL 33143

Billing Address

South Miami Hospital
Baptist Health South Florida Accounts Payable
8900 North Kendall Drive
Miami, FL 33176

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	010058700	1982688230

Shipping Addresses

Shipping Address 1

South Miami Hospital
Pulmonary Rehab
6250 Sunset Drive
South Miami, FL 33143

Shipping Address 2

Baptist Health South Florida
Baptist Health Pharmacy Shared Services Center
14408 Commerce Way
Miami Lakes, FL 33016

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
DSH100154A	Child	DSH	South Miami Hospital	Urgent Care Center - Brickell	2660 SW Brickell Avenue	Miami	FL	Active
DSH100154AA	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Emergency Department	9500 NW 58th Street	Doral	FL	Active
DSH100154AB	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Radiology - Diagnostic	9500 NW 58th Street	Doral	FL	Active
DSH100154AC	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Imaging CT Scan	9500 NW 58th Street	Doral	FL	Active
DSH100154AD	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Ultrasound	9500 NW 58th Street	Doral	FL	Active
DSH100154AE	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Respiratory Therapy	9500 NW 58th Street	Doral	FL	Active
DSH100154AF	Child	DSH	South Miami Hospital	Heart Rhythm Center - Heart Rhythm Center	7401 SW 62nd Ave	South Miami	FL	Active
DSH100154AG	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Imaging - MRI	9500 NW 58th Street	Doral	FL	Active
DSH100154AH	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Non-invasive Vascular Lab	9500 NW 58th Street	Doral	FL	Active
DSH100154AJ	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Surgery	9500 NW 58th Street	Doral	FL	Active
DSH100154AK	Child	DSH	South Miami Hospital	Lung Health Clinic - Lung Clinic	6250 Sunset Drive	South Miami	FL	Active
DSH100154AL	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - EKG - Stress Testing	9500 NW 58th Street	Doral	FL	Active
DSH100154AM	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Physical Therapy	9500 NW 58th Street	Doral	FL	Active
DSH100154B	Child	DSH	South Miami Hospital	Urgent Care Center - Coral Gables	10 Giralda Avenue	Coral Gables	FL	Active
DSH100154C	Child	DSH	South Miami Hospital	Urgent Care Center - Davie	4741 South University Drive	Davie	FL	Active
DSH100154D	Child	DSH	South Miami Hospital	Urgent Care Center - Doral	9915 NW 41 Street	Doral	FL	Active
DSH100154E	Child	DSH	South Miami Hospital	Urgent Care Center - Miami Lakes	14701 NW 77 Avenue	Miami Lakes	FL	Active
DSH100154F	Child	DSH	South Miami Hospital	Urgent Care Center - Pembroke Pines	15885 Pines Boulevard	Pembroke Pines	FL	Active
DSH100154G	Child	DSH	South Miami Hospital	Urgent Care Center - Sawgrass	12472 W Sunrise Boulevard	Sunrise	FL	Active
DSH100154H	Child	DSH	South Miami Hospital	Urgent Care Center - University Center	1240 South Dixie Highway	Miami	FL	Active
DSH100154J	Child	DSH	South Miami Hospital	Urgent Care Center - Weston	1642 Town Center Circle	Weston	FL	Active
DSH100154K	Child	DSH	South Miami Hospital	Urgent Care Center - Coral Springs	6264 West Sample Road	Coral Springs	FL	Active
DSH100154L	Child	DSH	South Miami Hospital	Urgent Care Center - Miami Beach	709 Alton Road	Miami Beach	FL	Active
DSH100154M	Child	DSH	South Miami Hospital	Child Development Center - Clinic	7401 SW 62nd Ave	South Miami	FL	Active
DSH100154N	Child	DSH	South Miami Hospital	Wound Care - Clinic	6250 Sunset Drive	South Miami	FL	Active
DSH100154P	Child	DSH	South Miami Hospital	Pelvic Health - Clinic	7401 SW 62nd Ave	South Miami	FL	Active
DSH100154Q	Child	DSH	SOUTH MIAMI HOSPITAL	Burn Center - Clinic	6250 Sunset Drive	South Miami	FL	Terminated
DSH100154R	Child	DSH	South Miami Hospital	East Tower - Labor and Delivery	7401 SW 62nd Ave	South Miami	FL	Active
DSH100154S	Child	DSH	South Miami Hospital	Hyperbaric Medicine	6250 Sunset Drive	South Miami	FL	Active
DSH100154T	Child	DSH	South Miami Hospital	Pulmonary Rehab	6250 Sunset Drive	South Miami	FL	Active
DSH100154U	Child	DSH	South Miami Hospital	Nursing Unit - 5 East Tower	7401 SW 62nd Ave	South Miami	FL	Active
DSH100154V	Child	DSH	South Miami Hospital	Urgent Care Center - Downtown Doral	8400 NW 53rd Street	Doral	FL	Active
DSH100154W	Child	DSH	South Miami Hospital	Urgent Care Center - Plantation	1228 South Pine Island Rd	Plantation	FL	Active
DSH100154X	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Anesthesiology	9500 NW 58th Street	Doral	FL	Active
DSH100154Y	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Echocardiography	9500 NW 58th Street	Doral	FL	Active
DSH100154Z	Child	DSH	South Miami Hospital	Baptist Health Hospital Doral - Post Anesthesia Care Unit	9500 NW 58th Street	Doral	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
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 3:34:14 PM	8/28/2024 2:04:15 PM	8/28/2024 2:04 PM
Addresses	Billing Address	Update	Change Request	South Miami Hospital Baptist Health South Florida Accounts Payable PO Box 29002 Miami, FL 33102	South Miami Hospital Baptist Health South Florida Accounts Payable 8900 North Kendall Drive Miami, FL 33176	6/17/2024 1:07 PM
Addresses	Billing Address	Update	Change Request	South Miami Hospital Baptist Health South Florida - Accounts Payable 8900 North Kendall Drive Miami, FL 33176-2197	South Miami Hospital Baptist Health South Florida Accounts Payable PO Box 29002 Miami, FL 33102	2/14/2024 1:06 PM
Details	Last Recertification Date	Update	Recertification	9/15/2022 7:25:37 AM	9/1/2023 3:34:14 PM	9/1/2023 3:34 PM
Addresses	Shipping Address	Insert	Change Request		South Miami Hospital Pulmonary Rehab 6250 Sunset Drive South Miami, FL 33143	2/14/2023 7:04 AM
Addresses	Shipping Address	Insert	Change Request		Baptist Health South Florida Baptist Health Pharmacy Shared Services Center 14408 Commerce Way Miami Lakes, FL 33016	2/14/2023 7:04 AM
Details	Last Recertification Date	Update	Recertification	9/11/2021 2:52:22 PM	9/15/2022 7:25:37 AM	9/15/2022 7:25 AM
Details	Entity Subname	Update	Recertification	Pulmonary Rehab - Pulmonary Rehab	Pulmonary Rehab	9/15/2022 7:25 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 7:10:06 PM	9/11/2021 2:52:22 PM	9/11/2021 2:52 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
Contacts	Signed By	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 7:10 PM
Details	Last Recertification Date	Update	Recertification		8/18/2020 7:10:06 PM	8/18/2020 7:10 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	State	Update		Approved	Active	1/1/2020 12:04 AM
Contacts	Signed By	Insert	New Registration		Camejo, Madeline Vice President and Chief Pharmacy Officer Baptist Health South Florida 7865951130	10/23/2019 2:16 PM
Details	340B ID	Update	New Registration		DSH100154T	10/23/2019 2:16 PM
Details	Entity Subname	Update	New Registration	Pulmonary Rehab	Pulmonary Rehab - Pulmonary Rehab	10/23/2019 2:16 PM
Dates	Participating Approval Date	Update	New Registration		10/23/2019 2:16:03 PM	10/23/2019 2:16 PM
Details	State	Update	New Registration	Pending	Approved	10/23/2019 2:16 PM
Dates	Signed By Date	Update	New Registration		10/15/2019 10:11:08 PM	10/23/2019 2:16 PM
Dates	Start Date	Update	New Registration		1/1/2020 12:00:00 AM	10/23/2019 2:16 PM
Addresses	Main Address	Insert	New Registration		6250 Sunset Drive South Miami, FL 33143	10/15/2019 10:11 PM
Addresses	Billing Address	Insert	New Registration		South Miami Hospital Baptist Health South Florida - Accounts Payable 8900 North Kendall Drive Miami, FL 33176-2197	10/15/2019 10:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/15/2019 10:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		010058700	10/15/2019 10:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		FL	10/15/2019 10:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1982688230	10/15/2019 10:11 PM
Contacts	Primary Contact	Insert	New Registration		Marcelin, Halena Leah Director, Pharmacy Business Affairs Baptist Health South Florida 7866620785	10/15/2019 10:11 PM
Contacts	Authorizing Official	Insert	New Registration		Camejo, Madeline Vice President and Chief Pharmacy Officer Baptist Health South Florida 7865951130	10/15/2019 10:11 PM
Details	Last Recertification Date	Insert	New Registration			10/15/2019 10:11 PM
Details	Grant Number	Insert	New Registration			10/15/2019 10:11 PM
Details	340B ID	Insert	New Registration			10/15/2019 10:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/15/2019 10:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/15/2019 10:11 PM
Details	Medicare Provider Number	Insert	New Registration		100154	10/15/2019 10:11 PM
Details	Entity Name	Insert	New Registration		SOUTH MIAMI HOSPITAL	10/15/2019 10:11 PM
Details	Program Code	Insert	New Registration		DSH	10/15/2019 10:11 PM
Details	Entity Subname	Insert	New Registration		Pulmonary Rehab	10/15/2019 10:11 PM
Dates	Participating Approval Date	Insert	New Registration			10/15/2019 10:11 PM
Details	State	Insert	New Registration		Pending	10/15/2019 10:11 PM
Dates	Registration Date	Insert	New Registration		10/15/2019 10:11:05 PM	10/15/2019 10:11 PM
Dates	Signed By Date	Insert	New Registration			10/15/2019 10:11 PM
Dates	Start Date	Insert	New Registration			10/15/2019 10:11 PM
Terminations	Termination Comments	Insert	New Registration			10/15/2019 10:11 PM
Terminations	Termination Date	Insert	New Registration			10/15/2019 10:11 PM
Terminations	Termination Effective Date	Insert	New Registration			10/15/2019 10:11 PM
Terminations	Termination Reason	Insert	New Registration			10/15/2019 10:11 PM