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DSH100281A MEMORIAL HOSPITAL WEST (Active)
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Main Details
Name
MEMORIAL HOSPITAL WEST
Subdivision Name
MCI WEST BCC INFUS 3
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100281A
Medicare Provider Number
100281
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
12/11/2007
Participating Start Date
1/1/2008
Participating Approval Date
12/12/2007
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Memorial Hospital West
JOSEPH STUCZYNSKI, CEO
(954) 844-6871
Primary Contact
Memorial Healthcare System
Alexsandra Soto, Director, 340B Program
(954) 276-1771
Addresses
Street Address
12235 Pines Blvd.
PEMBROKE PINES, FL 33026
Billing Address
Memorial Healthcare System
PO Box 269001
Attn: Accounts Payable
Pembroke Pines, FL 33026
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/7/2010- AMDP- NETWORK- SOUTH BROWARD HOSPITAL DISTRICT; 4/7/08-REVISED TO SHIP-TO ADDRESS (WAS 603 N. FLAMINGO RD.)
12/11/2007
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