340B Drug Pricing Program Database
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DSH100038CC MEMORIAL REGIONAL HOSPITAL (Active)
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Main Details
Name
MEMORIAL REGIONAL HOSPITAL
Subdivision Name
BH Mind Body Wellness - Behavioral Health
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038CC
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/3/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/9/2024
Last Recertification Date
Contacts
Authorizing Official
Memorial Regional Hospital
AURELIO FERNANDEZ, CEO
(954) 265-5014
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
5595 S University Drive
Davie, FL 33328
Billing Address
Memorial Healthcare System
PO BOX 269001
Pembroke Pines, FL 33026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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