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DSH100281 MEMORIAL HOSPITAL WEST (Active)
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Main Details
Name
MEMORIAL HOSPITAL WEST
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100281
Medicare Provider Number
100281
Additional Details
Current Program Status
Active
Registration Date
10/11/2005
Participating Start Date
10/11/2005
Participating Approval Date
10/11/2005
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Memorial Hospital West
JOSEPH STUCZYNSKI, CEO
(954) 844-6871
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
703 NORTH FLAMINGO ROAD
PEMBROKE PINES, FL 33028
Billing Address
Memorial Healthcare System
PO Box 269001
Attn: Accounts Payable
Pembroke Pines, FL 33026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/7/2010- AMDP-NETWORK- SOUTH BROWARD HOSPITAL DISTRICT
10/11/2005
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