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DSH100307M ASCENSION ST. VINCENTS SOUTHSIDE HO (Active)
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Main Details
Name
ASCENSION ST. VINCENTS SOUTHSIDE HO
Subdivision Name
PULMONARY RIVERSIDE - Pulmonary
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100307M
Medicare Provider Number
100307
Outpatient Facility Provider Number
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
3 SHIRCLIFF WAY
STE 625
JACKSONVILLE, FL 32204-4776
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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