Covered Entity Details

DSH100038A MEMORIAL REGIONAL HOSPITAL (Active)

Main Details

Name

MEMORIAL REGIONAL HOSPITAL

Subdivision Name

Memorial Primary Care Clinic- Hollywood

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH100038A

Medicare Provider Number

100038

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/1/2004

Participating Start Date

7/1/2004

Participating Approval Date

5/16/2005

Last Recertification Date

8/13/2024

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

4105 PEMBROKE ROAD
HOLLYWOOD, FL 33021

Billing Address

Memorial Healthcare System
PO Box 269001
Attn: Accounts Payable
Pembroke Pines, FL 33026

Comment	Last Updated On
1 Item 1 to 3 of 3 Page: of 1 Page size:

1 Item 1 to 3 of 3 Page: of 1 Page size:
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09 ADDED SHIP TO; 7/26/06 NEW IN-HOUSE PHARMACY; 5/16/05 ADMIN CORRECTION REPLACES DSH33021A;	05/15/2012
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09 ADDED SHIP TO; 7/26/06 NEW IN-HOUSE PHARMACY; 5/16/05 ADMIN CORRECTION REPLACES DSH33021A;	01/21/2010
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON 10/15/09 ADDED SHIP TO; 7/26/06 NEW IN-HOUSE PHARMACY; 5/16/05 ADMIN CORRECTION REPLACES DSH33021A;	07/01/2004

340B Drug Pricing Program Database