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DSH100038E SOUTH BROWARD HOSPITAL DISTRICT DBA MEMORIAL REGIONAL HOSPITAL (Terminated)
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Main Details
Name
SOUTH BROWARD HOSPITAL DISTRICT DBA MEMORIAL REGIONAL HOSPITAL
Subdivision Name
SOUTH CAMPUS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100038E
Medicare Provider Number
100038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/6/2006
Participating Start Date
1/1/2007
Participating Approval Date
12/7/2006
Last Recertification Date
8/15/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Memorial Healthcare System
Peter Powers, CEO, Memorial Regional Hospital
(954) 265-5814
Primary Contact
Keith Fricker, Director, Pharmacy Contracting
(954) 276-5491
Addresses
Street Address
3600 WASHINGTON STREET
HOLLYWOOD, FL 33021
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON; 10/15/09 ADDED SHIP TO
05/15/2012
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON; 10/15/09 ADDED SHIP TO
01/21/2010
4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 12/18/09 AMDP APPROVED ON; 10/15/09 ADDED SHIP TO
12/06/2006
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