340B Drug Pricing Program Database
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DSH100088B BAPTIST MEDICAL CENTER (Terminated)
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Main Details
Name
BAPTIST MEDICAL CENTER
Subdivision Name
BAPTIST HOME HEALTH CARE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100088B
Medicare Provider Number
100088
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/23/2006
Participating Start Date
10/1/2006
Participating Approval Date
8/23/2006
Last Recertification Date
8/28/2020
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
Baptist Medical Center
Scott M. Wooten, SVP & CFO
(904) 202-3405
Primary Contact
Baptist Medical Center
Pamela Michelle Johnston, Sr 340B Pharmacy Specialist
(904) 202-5255
Addresses
Street Address
3563 PHILIPS HIGHWAY
SUITE 202
JACKSONVILLE, FL 32207
Billing Address
Baptist Medical Center
PO Box 45094
Jacksonville, FL 32207
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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