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DSH100022 JACKSON HEALTH SYSTEM (Active)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
JACKSON MEMORIAL HOSPITAL
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022
Medicare Provider Number
100022
Additional Details
Current Program Status
Active
Registration Date
12/5/2006
Participating Start Date
12/1/1992
Participating Approval Date
12/5/2006
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Jackson Health System
Carlos A. Migoya, CEO
(305) 585-6754
Primary Contact
Jackson Health System
VENESSA GOODNOW, AVP & CHIEF PHARMACY OFFICER
(305) 585-7411
Addresses
Street Address
1611 NW 12 AVE.
MIAMI, FL 33136
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/17/08-REVISED NAME (WAS JACKSON MEMORIAL HOSPITAL); 7/1/08-ADDED NPI 1568578367
12/05/2006
May 2025
May 2025
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