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DSH100025M SACRED HEART HEALTH SYSTEM (Terminated)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
SACRED HEART MEDICAL ONCOLOGY GROUP AT MILTON
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025M
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/30/2007
Participating Start Date
10/1/2007
Participating Approval Date
9/4/2007
Last Recertification Date
11/16/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Sacred Heart Health System, Inc.
Susan Cornejo, Chief Operating Officer
(850) 416-6206
Primary Contact
Sacred Heart Health System, Inc.
Troy Russo, 340B Coordinator
(850) 416-2859
Addresses
Street Address
5992 Berryhill Road
Suite 302
MILTON, FL 32570
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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