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DSH100022A JACKSON HEALTH SYSTEM (Active)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
PUBLIC HEALTH TRUST OF DADE COUNTY NORTH DADE HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022A
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/5/2006
Participating Start Date
4/1/1996
Participating Approval Date
12/5/2006
Last Recertification Date
8/29/2024
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
16555 N.W. 25TH AVE
Opa Locka, FL 33054
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/17/09 UPDATED SUBDIVISION NAME (WAS NORTH DADE HEALTH CLINIC); 9/17/08-REVISED NAME (WAS JACKSON MEMORIAL HOSPITAL)
12/05/2006
April 2025
April 2025
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