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DSH100022B JACKSON HEALTH SYSTEM (Active)
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Main Details
Name
JACKSON HEALTH SYSTEM
Subdivision Name
MENTAL HEALTH HOSPITAL CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100022B
Medicare Provider Number
100022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/5/2006
Participating Start Date
10/1/1999
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
1695 N.W. 9TH AVENUE
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)
12/05/2006
April 2025
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