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DSH100025E SACRED HEART HEALTH SYSTEM (Terminated)
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Main Details
Name
SACRED HEART HEALTH SYSTEM
Subdivision Name
MEDICAL GROUP
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100025E
Medicare Provider Number
100025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/4/2007
Participating Start Date
7/1/2004
Participating Approval Date
9/4/2007
Last Recertification Date
8/19/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Sacred Heart Health System, Inc.
Susan Cornejo, Chief Operating Officer
(850) 416-6206
Primary Contact
Steve Poole, Director Medical Practices
(850) 416-7039
Addresses
Street Address
4451 BAYOU BLVD.
PENSACOLA, FL 32503
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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