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DSH100307 ASCENSION ST. VINCENTS SOUTHSIDE HO (Active)
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Main Details
Name
ASCENSION ST. VINCENTS SOUTHSIDE HO
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100307
Medicare Provider Number
100307
Additional Details
Current Program Status
Active
Registration Date
1/1/2025
Participating Start Date
1/21/2025
Participating Approval Date
1/21/2025
Last Recertification Date
Contacts
Authorizing Official
Sacred Heart Health System, Inc.
Susan Cornejo, Chief Operating Officer
(850) 416-6206
Primary Contact
Sacred Heart Health System, Inc.
Troy Russo, 340B Coordinator
(850) 416-2859
Addresses
Street Address
4201 BELFORT ROAD
JACKSONVILLE, FL 32216
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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